Provider Demographics
NPI:1679303747
Name:STOVER, JOHNNY MICHAEL JR (LMSW)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:MICHAEL
Last Name:STOVER
Suffix:JR
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 VANTAGE WAY
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1515
Mailing Address - Country:US
Mailing Address - Phone:615-988-4763
Mailing Address - Fax:
Practice Address - Street 1:1 VANTAGE WAY
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37228-1515
Practice Address - Country:US
Practice Address - Phone:615-988-4763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15525104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker