Provider Demographics
NPI:1477658441
Name:PATTERSON, CARRIE SPAKE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:SPAKE
Last Name:PATTERSON
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 1:243 GERMANTOWN BEND CV STE 101
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4251
Mailing Address - Country:US
Mailing Address - Phone:901-761-9178
Mailing Address - Fax:
Practice Address - Street 1:243 GERMANTOWN BEND CV STE 101
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4251
Practice Address - Country:US
Practice Address - Phone:901-761-9178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000030731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3695890Medicare PIN