Provider Demographics
NPI:1023021318
Name:PRESHONG, MARK ANTHONY (MSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANTHONY
Last Name:PRESHONG
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3319 BONDWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-8904
Mailing Address - Country:US
Mailing Address - Phone:423-283-7257
Mailing Address - Fax:
Practice Address - Street 1:JAMES H. QUILLEN VA MEDICAL CEENTER
Practice Address - Street 2:CORNER OF SIDENY AND LAMONT STREET
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-979-2954
Practice Address - Fax:423-979-3451
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCSW0000005431104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker