Provider Demographics
NPI:1740376011
Name:BRITTON, DIANNE RUZICKA (LCSW,ACSW)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:RUZICKA
Last Name:BRITTON
Suffix:
Gender:F
Credentials:LCSW,ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 DUCK COVE DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-6117
Mailing Address - Country:US
Mailing Address - Phone:865-966-1090
Mailing Address - Fax:865-671-4390
Practice Address - Street 1:239 JAMESTOWNE BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-2727
Practice Address - Country:US
Practice Address - Phone:865-966-1090
Practice Address - Fax:865-671-4390
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW6781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
11699895OtherCAQH