Provider Demographics
NPI:1689615320
Name:NETHERY, DAMIEN ERIC (LCSW)
Entity Type:Individual
Prefix:
First Name:DAMIEN
Middle Name:ERIC
Last Name:NETHERY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 HIGHWAY 51 S
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:TN
Mailing Address - Zip Code:38063-4580
Mailing Address - Country:US
Mailing Address - Phone:731-635-8189
Mailing Address - Fax:731-635-8121
Practice Address - Street 1:79 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:TN
Practice Address - Zip Code:38063-4580
Practice Address - Country:US
Practice Address - Phone:731-635-8189
Practice Address - Fax:731-635-8121
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical