Provider Demographics
NPI:1164280145
Name:HOSS, DESAREI DAWN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DESAREI
Middle Name:DAWN
Last Name:HOSS
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 1:3101 W. MARKET W. MARKET ST.
Mailing Address - Street 2:SUITE 109 - 550
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604
Mailing Address - Country:US
Mailing Address - Phone:423-430-8068
Mailing Address - Fax:
Practice Address - Street 1:3101 W. MARKET W. MARKET ST.
Practice Address - Street 2:SUITE 109 - 550
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604
Practice Address - Country:US
Practice Address - Phone:423-430-8068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000076841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical