Provider Demographics
NPI:1578562757
Name:EDDLEMON, LAURA CATHARINE (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:CATHARINE
Last Name:EDDLEMON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:CATHERINE
Other - Last Name:RAYMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1318 GRAINGER AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-5709
Mailing Address - Country:US
Mailing Address - Phone:865-522-9534
Mailing Address - Fax:
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:865-588-3137
Practice Address - Fax:865-588-3174
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW43931041C0700X
TNCSW52701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3927375Medicaid
TN3927375Medicaid