Healthcare Provider Details

I. General information

NPI: 1841852548
Provider Name (Legal Business Name): RACHEL M DISNEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

482 INTERSTATE DR STE D
MANCHESTER TN
37355-3409
US

IV. Provider business mailing address

1129 CLAY CT
MURFREESBORO TN
37128-3691
US

V. Phone/Fax

Practice location:
  • Phone: 931-444-1000
  • Fax: 931-728-1229
Mailing address:
  • Phone: 931-580-6820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6960
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: