Provider Demographics
NPI:1598836579
Name:RIVERS, ANITA TREADWAY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:TREADWAY
Last Name:RIVERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ANITA
Other - Middle Name:P
Other - Last Name:TREADWAY-RIVERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3703 HIXSON PIKE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-3552
Mailing Address - Country:US
Mailing Address - Phone:423-877-5990
Mailing Address - Fax:423-305-1963
Practice Address - Street 1:3703 HIXSON PIKE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415
Practice Address - Country:US
Practice Address - Phone:423-877-5990
Practice Address - Fax:423-305-1963
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000035691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3115112OtherBLUE CROSS
TN585923000OtherMAGELLAN AND TENNCARE