Provider Demographics
NPI:1184968810
Name:BOOTHE, NAOMI (LPC/MHSP, MAC, NCC)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:BOOTHE
Suffix:
Gender:F
Credentials:LPC/MHSP, MAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 RIO VISTA DR
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-5147
Mailing Address - Country:US
Mailing Address - Phone:423-650-9101
Mailing Address - Fax:
Practice Address - Street 1:1222 TREMONT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-3038
Practice Address - Country:US
Practice Address - Phone:423-847-2535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000002685101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional