Healthcare Provider Details

I. General information

NPI: 1477929917
Provider Name (Legal Business Name): AMY WHITE DILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY WHITE LCSW

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 S CHURCH ST STE 104
MURFREESBORO TN
37130-5551
US

IV. Provider business mailing address

301 S PERIMETER PARK DR SUITE 210
NASHVILLE TN
37211-4143
US

V. Phone/Fax

Practice location:
  • Phone: 615-295-2176
  • Fax: 615-295-2645
Mailing address:
  • Phone: 615-295-2176
  • Fax: 615-295-2645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4362
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: