Provider Demographics
NPI:1619954609
Name:DEPUGH, DIANA J (MSW)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:J
Last Name:DEPUGH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 PLEASANT TRACE CIR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37912-6207
Mailing Address - Country:US
Mailing Address - Phone:865-748-4476
Mailing Address - Fax:
Practice Address - Street 1:4928 HOMBERG DR
Practice Address - Street 2:SUIE 4-A
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5100
Practice Address - Country:US
Practice Address - Phone:865-748-4476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDC00000086101YA0400X
TNLSW00000035511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1100250OtherCIGNA
TN1100250OtherCIGNA