Provider Demographics
NPI:1922181817
Name:HARGROVES, LYNDA BARRETT (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LYNDA
Middle Name:BARRETT
Last Name:HARGROVES
Suffix:
Gender:F
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:PO BOX 114
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37621-0114
Mailing Address - Country:US
Mailing Address - Phone:423-952-4666
Mailing Address - Fax:
Practice Address - Street 1:4132 BRISTOL HWY
Practice Address - Street 2:PARKSIDE CENTER SUITE 3
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2932
Practice Address - Country:US
Practice Address - Phone:423-952-4666
Practice Address - Fax:276-794-7965
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000003529101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNLSW0000003529OtherLCSW LICENSE NO
TNLSW0000003529OtherLCSW LICENSE NO