Provider Demographics
NPI:1336312685
Name:ROANE, LYDIA PIPES (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:PIPES
Last Name:ROANE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LYDIA
Other - Middle Name:F
Other - Last Name:PIPES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:703 HIWASSEE HILL DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-7603
Mailing Address - Country:US
Mailing Address - Phone:423-283-0097
Mailing Address - Fax:423-283-0097
Practice Address - Street 1:703 HIWASSEE HILL DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-7603
Practice Address - Country:US
Practice Address - Phone:423-283-0097
Practice Address - Fax:423-283-0097
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000049351041C0700X
LA30311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical