| Doctor Name: | JANICE S FREDERICKS |
| NPI Number: | 1538185129 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | LCSW0000003418 |
| Business Practice Address: | 919 Medical Park Dr Mountain City, TN - 376831042 |
| Business Phone Number: | 4232821480 |
| Business Fax Number: | 4239281353 |
| Mailing Address: | 119 Boone Ridge Dr, Suite 201 JOHNSON CITY |
| State: | TN |
| Postal Code: | 376154998 |
| Phone Number: | 4232821480 |
| Fax Number: | 4239281353 |
| NPI Enumeration Date: | 07/15/2006 |
| NPI Last Update Date: | 05/05/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LCSW0000003418 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |