Provider Demographics
NPI:1407947971
Name:HARTGROVE, BRENDA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:HARTGROVE
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:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37371
Mailing Address - Country:US
Mailing Address - Phone:423-507-8826
Mailing Address - Fax:423-507-8791
Practice Address - Street 1:3505 ADKISSON DR NW STE 211
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-6805
Practice Address - Country:US
Practice Address - Phone:423-473-6731
Practice Address - Fax:423-709-9920
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000000735101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3692988Medicare ID - Type Unspecified