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General NPI Number Information
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NPI Number | 1881758548
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Entity Type | Individual
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Provider Name | DOREEN GEORGINA LEO-HUNEKE L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 11/03/2011
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Provider Practice Location Address
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Address Line | 1110 HIDE AWAY LN
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City | KODAK
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State | TN
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Zip | 37764-2600
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Country | US
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Telephone | 865-850-9745
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Fax | 865-933-6015
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Provider Business Mailing Address
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Address Line | 1110 HIDE AWAY LN
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City | KODAK
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State | TN
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Zip | 37764-2600
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Country | US
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Telephone | 865-850-9745
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Fax | 865-933-6015
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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 | 4726
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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 | R052355-1
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License Number State | NY
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