Provider Demographics
NPI:1295260537
Name:KETRON, GINGER Y (LCSW)
Entity type:Individual
Prefix:MRS
First Name:GINGER
Middle Name:Y
Last Name:KETRON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:GINGER
Other - Middle Name:Y
Other - Last Name:MADDUX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1131 ANTIOCH RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6379
Mailing Address - Country:US
Mailing Address - Phone:423-430-6659
Mailing Address - Fax:
Practice Address - Street 1:2306 KNOB CREEK RD STE 100
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2366
Practice Address - Country:US
Practice Address - Phone:423-430-6659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
TN84141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical