Provider Demographics
NPI:1699813873
Name:DAUGHERTY, VICKIE M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:M
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3223 JOHNSTON ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37921-1910
Mailing Address - Country:US
Mailing Address - Phone:865-603-3260
Mailing Address - Fax:
Practice Address - Street 1:5833 CLINTON HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37912-2556
Practice Address - Country:US
Practice Address - Phone:865-603-3260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN54091041C0700X
TNCSW00000056871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ044310Medicaid