Provider Demographics
NPI:1790859981
Name:WALKER, TRACIE (MSSW-LCSW)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:MSSW-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 S PETERS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-5207
Mailing Address - Country:US
Mailing Address - Phone:865-719-4709
Mailing Address - Fax:865-238-5909
Practice Address - Street 1:224 S PETERS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5207
Practice Address - Country:US
Practice Address - Phone:865-719-4709
Practice Address - Fax:865-238-5909
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000043201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
39201021Medicare PIN