Provider Demographics
NPI:1437108883
Name:POWELL, DENISE C (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:C
Last Name:POWELL
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 1:8810 HURRICANE MANOR TRL
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4524
Mailing Address - Country:US
Mailing Address - Phone:423-855-7977
Mailing Address - Fax:423-855-7976
Practice Address - Street 1:6918 SHALLOWFORD RD
Practice Address - Street 2:SUITE 317
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-6784
Practice Address - Country:US
Practice Address - Phone:423-855-7977
Practice Address - Fax:423-855-7976
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000044441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0408238OtherBCBS PROVIDER ID
TNLSW0000004444OtherLCSW
TN39727807Medicare ID - Type UnspecifiedPROVIDER ID