Provider Demographics
NPI:1215912878
Name:COHAN, DEBRA DIANNE (LCSW)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:DIANNE
Last Name:COHAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:DIANNE
Other - Last Name:COHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:6800 BAUM DR
Mailing Address - Street 2:BLDG. 1
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-7315
Mailing Address - Country:US
Mailing Address - Phone:865-374-7156
Mailing Address - Fax:865-374-7155
Practice Address - Street 1:6800 BAUM DR
Practice Address - Street 2:BLDG. 1
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-7315
Practice Address - Country:US
Practice Address - Phone:865-374-7156
Practice Address - Fax:865-374-7155
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000038791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
4039053OtherBLUE CROSS BLUE SHIELD
4763900000OtherMAGELLAN
4763900000OtherAETNA
TN3921244Medicaid
TN3921244Medicaid