Provider Demographics
NPI:1124197041
Name:RHODES, KATHRYN W (LCSW)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:W
Last Name:RHODES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7302 JARNIGAN RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3042
Mailing Address - Country:US
Mailing Address - Phone:423-855-4091
Mailing Address - Fax:423-855-8928
Practice Address - Street 1:7302 JARNIGAN RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3042
Practice Address - Country:US
Practice Address - Phone:423-855-4091
Practice Address - Fax:423-855-8928
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3697615Medicaid
TN3697615Medicare ID - Type Unspecified