Provider Demographics
NPI:1568647105
Name:RACHEL B. DORRIS, LCSW, LLC
Entity Type:Organization
Organization Name:RACHEL B. DORRIS, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:BRIMM
Authorized Official - Last Name:DORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:615-451-0250
Mailing Address - Street 1:150 N. MAIN ST.
Mailing Address - Street 2:SUITE 303
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-3251
Mailing Address - Country:US
Mailing Address - Phone:615-451-0250
Mailing Address - Fax:615-451-0240
Practice Address - Street 1:150 N. MAIN ST.
Practice Address - Street 2:SUITE 303
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-3251
Practice Address - Country:US
Practice Address - Phone:615-451-0250
Practice Address - Fax:615-451-0240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1104997337OtherNPI
TN3920092Medicaid