Provider Demographics
NPI:1679655070
Name:WARING-VINCENT, ELISE F (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELISE
Middle Name:F
Last Name:WARING-VINCENT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ELISE
Other - Middle Name:F
Other - Last Name:WARING-VINCENT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:617 POTOMAC PL
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-5657
Mailing Address - Country:US
Mailing Address - Phone:615-267-0779
Mailing Address - Fax:615-625-3371
Practice Address - Street 1:617 POTOMAC PL
Practice Address - Street 2:SUITE 401
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-5657
Practice Address - Country:US
Practice Address - Phone:615-267-0779
Practice Address - Fax:615-625-3371
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN11521649OtherCAQH
TN11521649OtherCAQH