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General NPI Number Information
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NPI Number | 1295260537
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Entity Type | Individual
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Provider Name | GINGER Y KETRON LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/24/2017
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Last Update Date | 01/23/2024
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Provider Practice Location Address
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Address Line | 2306 KNOB CREEK RD STE 100
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2366
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Country | US
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Telephone | 423-430-6659
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Fax |
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Provider Business Mailing Address
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Address Line | 1131 ANTIOCH RD
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City | JOHNSON CITY
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State | TN
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Zip | 37604-6379
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Country | US
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Telephone | 423-430-6659
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8414
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License Number State | TN
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