Provider Demographics
NPI:1689778672
Name:ROSE, MARSHA G (MSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:G
Last Name:ROSE
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:MARSHA
Other - Middle Name:
Other - Last Name:JOYNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3696
Practice Address - Street 1:2001 STONEBROOK PLACE
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660
Practice Address - Country:US
Practice Address - Phone:423-224-1000
Practice Address - Fax:423-224-1023
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLCSW4305104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
3920247OtherGRP MEDICARE TN
3920247OtherTN MEDICAID CROSSO GROUP
3927531OtherMEDICARE TN
334969OtherVALUE OPTIONS GROUP
4095639OtherMAGELLAN SUMMIT
183856OtherANTHEM PROF TRIGON
3927531OtherTN MEDICAID CROSSO
183856OtherANTHEM PREF TRIGON
2224731OtherFIRST HEALTH
4095639OtherMAGELLAN NAVIGATOR
4095639OtherMAGELLAN PINNACLE