Provider Demographics
NPI:1316364136
Name:NASH, MIRAQUITA D
Entity Type:Individual
Prefix:
First Name:MIRAQUITA
Middle Name:D
Last Name:NASH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIRA
Other - Middle Name:
Other - Last Name:NASH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:140 DAMERON AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-6413
Mailing Address - Country:US
Mailing Address - Phone:865-215-5320
Mailing Address - Fax:865-215-5340
Practice Address - Street 1:140 DAMERON AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-6413
Practice Address - Country:US
Practice Address - Phone:865-215-5320
Practice Address - Fax:865-215-5340
Is Sole Proprietor?:No
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor