Provider Demographics
NPI:1942873922
Name:BIERBAUM, AUDREY JEAN (LCSW)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:JEAN
Last Name:BIERBAUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-1704
Mailing Address - Country:US
Mailing Address - Phone:423-220-7029
Mailing Address - Fax:423-573-2226
Practice Address - Street 1:204 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1704
Practice Address - Country:US
Practice Address - Phone:423-220-7029
Practice Address - Fax:423-573-2226
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN77161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical