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General NPI Number Information
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NPI Number | 1427442151
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Entity Type | Organization
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Legal Business Name | BLOUNT COUNTY CHILDREN'S ADVOCACY CENTER
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Dates
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Enumeration Date | 03/19/2015
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Last Update Date | 08/04/2015
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Provider Practice Location Address
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Address Line | 212 CATES ST
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City | MARYVILLE
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State | TN
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Zip | 37801-4902
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Country | US
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Telephone | 865-981-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 212 CATES ST
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City | MARYVILLE
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State | TN
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Zip | 37801-4902
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Country | US
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Telephone | 865-981-2000
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. TABITHA B. DAMRON
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Credential | LCSW
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Telephone | 865-981-2000
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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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