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General NPI Number Information
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NPI Number | 1538744313
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Entity Type | Individual
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Provider Name | KORRIE XAVIER LMSW
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Gender | Male
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Dates
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Enumeration Date | 03/13/2021
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Last Update Date | 09/07/2021
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Provider Practice Location Address
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Address Line | 1700 ELM DR
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City | MARYVILLE
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State | TN
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Zip | 37804-4327
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Country | US
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Telephone | 865-309-5427
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5568
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City | MARYVILLE
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State | TN
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Zip | 37802-5568
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Country | US
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Telephone | 865-351-0393
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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 | LSW0000013022
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License Number State | TN
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