Provider Demographics
NPI:1982637583
Name:DUARTE, BRENDA-LEE WILDER (LPC-MHSP)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA-LEE
Middle Name:WILDER
Last Name:DUARTE
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 GAMBLE AVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-4943
Mailing Address - Country:US
Mailing Address - Phone:865-981-7400
Mailing Address - Fax:
Practice Address - Street 1:294 GAMBLE AVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-4943
Practice Address - Country:US
Practice Address - Phone:865-981-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000686101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health