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General NPI Number Information
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NPI Number | 1598250359
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Entity Type | Individual
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Provider Name | PATRICIA LYNN WHARTON LADAC 2, NCAC 1
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Gender | Female
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 06/25/2018
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Provider Practice Location Address
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Address Line | 547 W LAMAR ALEXANDER PKWY
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City | MARYVILLE
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State | TN
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Zip | 37801-4760
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Country | US
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Telephone | 865-518-2433
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Fax | 865-318-9025
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Provider Business Mailing Address
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Address Line | 547 W LAMAR ALEXANDER PKWY
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City | MARYVILLE
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State | TN
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Zip | 37801-4760
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Country | US
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Telephone | 865-518-2433
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Fax | 865-318-9025
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1210
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License Number State | TN
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