Provider Demographics
NPI:1942304639
Name:SARTAIN, CARRIE ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANN
Last Name:SARTAIN
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 4000
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684-4000
Mailing Address - Country:US
Mailing Address - Phone:423-926-1171
Mailing Address - Fax:
Practice Address - Street 1:320 CLARK ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-4444
Practice Address - Country:US
Practice Address - Phone:423-926-2234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000004562104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3920247OtherMEDICAID CROSSO GRP
4104174OtherMAGELLAN SUMMIT
4104174OtherMAGELLAN NAVIGATOR
181764OtherANTHEM PROF TRIGON
181764OtherANTHEM PREF TRIGON
364756OtherMANAGED HEALTH NET
4104174OtherMAGELLAN PINNACLE
334969OtherVALUE OPTIONS
TN3989810OtherMEDICAID CROSSO
TN3989810OtherMEDICAID CROSSO