Provider Demographics
NPI:1770640757
Name:DE GRAAF, NATHAN A (LCSW)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:A
Last Name:DE GRAAF
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 1:103 DEER RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-5078
Mailing Address - Country:US
Mailing Address - Phone:615-826-8290
Mailing Address - Fax:615-826-8290
Practice Address - Street 1:623 E MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2641
Practice Address - Country:US
Practice Address - Phone:615-828-8488
Practice Address - Fax:615-826-8290
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3924185Medicare ID - Type Unspecified