Healthcare Provider Details

I. General information

NPI: 1134469224
Provider Name (Legal Business Name): VALERIE VOTAW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2013
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E BROOKLYN ST
LINDEN TN
37096-3515
US

IV. Provider business mailing address

82 ALDRIDGE CIR
LINDEN TN
37096-6068
US

V. Phone/Fax

Practice location:
  • Phone: 931-589-2104
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4831
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: