Provider Demographics
NPI:1437136421
Name:RUPEKA, CAROL ANN (MSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:RUPEKA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 ASHWORTH TRL
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-3065
Mailing Address - Country:US
Mailing Address - Phone:865-384-7378
Mailing Address - Fax:
Practice Address - Street 1:3105 ESSARY RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-2409
Practice Address - Country:US
Practice Address - Phone:865-384-7378
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC384450101Y00000X
TNLADAC3844509101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)