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General NPI Number Information
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NPI Number | 1619954609
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Entity Type | Individual
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Provider Name | DIANA J DEPUGH MSW
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Gender | Female
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Dates
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Enumeration Date | 12/29/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 4928 HOMBERG DR SUIE 4-A
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City | KNOXVILLE
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State | TN
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Zip | 37919-5100
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Country | US
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Telephone | 865-748-4476
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Fax |
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Provider Business Mailing Address
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Address Line | 3110 PLEASANT TRACE CIR
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City | KNOXVILLE
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State | TN
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Zip | 37912-6207
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Country | US
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Telephone | 865-748-4476
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LDC00000086
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License Number State | TN
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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 | LSW0000003551
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License Number State | TN
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