Provider Demographics
NPI:1679672513
Name:DEETER, ELIZABETH JOANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:JOANNE
Last Name:DEETER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:BETSY
Other - Middle Name:J
Other - Last Name:DEETER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:108 W SUMMIT HILL DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37902
Mailing Address - Country:US
Mailing Address - Phone:865-525-1099
Mailing Address - Fax:865-525-7494
Practice Address - Street 1:108 W SUMMIT HILL DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37902
Practice Address - Country:US
Practice Address - Phone:865-525-1099
Practice Address - Fax:865-525-7494
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000033061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2927788Medicaid
TN4099564OtherBCBS TN
TN2927788Medicaid