Provider Demographics
NPI:1609123231
Name:DENTON, MILDRED ELAINE (LMSW- TN, LCSW- VA)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:ELAINE
Last Name:DENTON
Suffix:
Gender:F
Credentials:LMSW- TN, LCSW- VA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 SOUTH HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:BLOUNTVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37617
Mailing Address - Country:US
Mailing Address - Phone:423-967-7119
Mailing Address - Fax:
Practice Address - Street 1:309 SOUTH HOLLOW RD
Practice Address - Street 2:
Practice Address - City:BLOUNTVILLE
Practice Address - State:TN
Practice Address - Zip Code:37617
Practice Address - Country:US
Practice Address - Phone:423-967-7119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW7683104100000X
VA09040077181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker