Provider Demographics
NPI:1598250359
Name:WHARTON, PATRICIA LYNN (LADAC 2, NCAC 1)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LYNN
Last Name:WHARTON
Suffix:
Gender:F
Credentials:LADAC 2, NCAC 1
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:LYNN
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LADAC 2
Mailing Address - Street 1:547 W LAMAR ALEXANDER PKWY
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-4760
Mailing Address - Country:US
Mailing Address - Phone:865-518-2433
Mailing Address - Fax:865-318-9025
Practice Address - Street 1:547 W LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-4760
Practice Address - Country:US
Practice Address - Phone:865-518-2433
Practice Address - Fax:865-318-9025
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1210101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty