Provider Demographics
NPI:1407477664
Name:DUKE, ROSANNA CANDACE
Entity Type:Individual
Prefix:MISS
First Name:ROSANNA
Middle Name:CANDACE
Last Name:DUKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TN
Mailing Address - Zip Code:38474-1137
Mailing Address - Country:US
Mailing Address - Phone:931-797-2453
Mailing Address - Fax:
Practice Address - Street 1:2122 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4430
Practice Address - Country:US
Practice Address - Phone:931-797-2453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness