Provider Demographics
NPI:1326051186
Name:DALTON, PATRICIA R (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:R
Last Name:DALTON
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 1:807 POETS CORNER WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-7198
Mailing Address - Country:US
Mailing Address - Phone:865-584-0171
Mailing Address - Fax:865-584-0174
Practice Address - Street 1:1111 N NORTHSHORE DR
Practice Address - Street 2:SUITE S-490
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4005
Practice Address - Country:US
Practice Address - Phone:865-584-0171
Practice Address - Fax:865-584-0174
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000001741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3693508Medicare ID - Type Unspecified