Provider Demographics
NPI:1326534835
Name:PETMECKY, ADRIENE (LCSW, CT)
Entity Type:Individual
Prefix:
First Name:ADRIENE
Middle Name:
Last Name:PETMECKY
Suffix:
Gender:F
Credentials:LCSW, CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 N MARKET ST UNIT 4302
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-4359
Mailing Address - Country:US
Mailing Address - Phone:423-356-2522
Mailing Address - Fax:
Practice Address - Street 1:199 RIVER ST STE A
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-4007
Practice Address - Country:US
Practice Address - Phone:423-356-2522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48261041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical