Provider Demographics
NPI:1558315374
Name:DEATON, KIMBERLY CLAYTON (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:CLAYTON
Last Name:DEATON
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 1:5410 HOMBERG DR
Mailing Address - Street 2:SUITE 14
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5031
Mailing Address - Country:US
Mailing Address - Phone:865-588-3173
Mailing Address - Fax:865-588-3174
Practice Address - Street 1:5410 HOMBERG DR
Practice Address - Street 2:SUITE 14
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5031
Practice Address - Country:US
Practice Address - Phone:865-588-3173
Practice Address - Fax:865-588-3174
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000042601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4112215OtherBLUE CROSS/ BLUE SHIELD
TN366434OtherMANAGED HEALTH NETWORK
TN1224236OtherCHA