Provider Demographics
NPI:1922021880
Name:THACKER, DENNIS HARLEY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:HARLEY
Last Name:THACKER
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 1:209 GINGER CT
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-6005
Mailing Address - Country:US
Mailing Address - Phone:423-979-2872
Mailing Address - Fax:423-979-2872
Practice Address - Street 1:CORNER OF SIDNEY AND LAMONT ST
Practice Address - Street 2:JAMES H. QUILLEN VAMC
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-979-2872
Practice Address - Fax:423-979-2812
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0049941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical