Provider Demographics
NPI:1851614564
Name:DEBORD, RONALD OWEN JR (LCSW)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:OWEN
Last Name:DEBORD
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:RON
Other - Middle Name:O
Other - Last Name:DEBORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1451 DOWELL SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2441
Mailing Address - Country:US
Mailing Address - Phone:865-970-9800
Mailing Address - Fax:865-374-7317
Practice Address - Street 1:1451 DOWELL SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2441
Practice Address - Country:US
Practice Address - Phone:865-970-9800
Practice Address - Fax:865-374-7317
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW51901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1518354Medicaid