Provider Demographics
NPI:1619014768
Name:DE SOUZA, LIANE VIDERES (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LIANE
Middle Name:VIDERES
Last Name:DE SOUZA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 775
Mailing Address - Street 2:
Mailing Address - City:COLLEGEDALE
Mailing Address - State:TN
Mailing Address - Zip Code:37315-0775
Mailing Address - Country:US
Mailing Address - Phone:423-236-2081
Mailing Address - Fax:423-236-1782
Practice Address - Street 1:4881 TAYLOR CIRCLE
Practice Address - Street 2:
Practice Address - City:COLLEGEDALE
Practice Address - State:TN
Practice Address - Zip Code:37315
Practice Address - Country:US
Practice Address - Phone:423-236-2081
Practice Address - Fax:423-263-1782
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC1630101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional