Provider Demographics
NPI:1083627160
Name:DUNCAN, CHAD LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:LEE
Last Name:DUNCAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3696
Practice Address - Street 1:101 LENA DR
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857-2951
Practice Address - Country:US
Practice Address - Phone:423-272-9239
Practice Address - Fax:423-272-1803
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
TNLCSW50291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2229186OtherCOMPSYCH
TNNPIOtherHORIZON HEALTH EAP
TN1512731Medicaid
TNNPIOtherADVANTAGE BEHAVIORAL HEALTH
TNNPIOtherINITIAL GROUP
TNNPIOtherTHREE RIVERS
TNNPIOtherPRIME HEALTH SRVICES
TNNPIOtherLIFESYNCH
TN334969 GROUP#OtherVALUEOPTIONS
TN4223888OtherMAGELLAN
TNNPIOtherMENTAL HEALTH NETWORK
TNNPIOtherHORIZON BEHAVIORAL
TNNPIOtherHORIZON BEHAVIORAL