Provider Demographics
NPI:1710932314
Name:FRIEND, DAVID R (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:R
Last Name:FRIEND
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:R
Other - Last Name:FRIEND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 7365
Mailing Address - Street 2:KNOXVILLE
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37921
Mailing Address - Country:US
Mailing Address - Phone:865-219-9559
Mailing Address - Fax:
Practice Address - Street 1:9631 W EMORY RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37931-1412
Practice Address - Country:US
Practice Address - Phone:865-219-9559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW104591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ815863OtherAHCCCS