Provider Demographics
NPI:1417104290
Name:DOREAU, EDWARD KNIGHT (LPC, MHSP)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:KNIGHT
Last Name:DOREAU
Suffix:
Gender:M
Credentials:LPC, MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 MCCALLIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3026
Mailing Address - Country:US
Mailing Address - Phone:423-756-2894
Mailing Address - Fax:
Practice Address - Street 1:1815 MCCALLIE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3026
Practice Address - Country:US
Practice Address - Phone:423-756-2894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2971OtherTENNESSEE BOARD FOR LICENSED COUNSELORS