Provider Demographics
NPI:1134887227
Name:HUMPHREYS-BARLOW, DIANE (MSW)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:HUMPHREYS-BARLOW
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 BOOTH ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-2306
Mailing Address - Country:US
Mailing Address - Phone:865-546-0447
Mailing Address - Fax:
Practice Address - Street 1:505 BOOTH ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-2306
Practice Address - Country:US
Practice Address - Phone:865-546-0447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty