Provider Demographics
NPI:1740348622
Name:DIFTLER, DONA ELLEN (MSSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:DONA
Middle Name:ELLEN
Last Name:DIFTLER
Suffix:
Gender:F
Credentials:MSSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4645 NEWCOM AVE
Mailing Address - Street 2:#139
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5131
Mailing Address - Country:US
Mailing Address - Phone:865-588-0488
Mailing Address - Fax:865-673-8059
Practice Address - Street 1:4645 NEWCOM AVE
Practice Address - Street 2:#139
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5131
Practice Address - Country:US
Practice Address - Phone:865-588-0488
Practice Address - Fax:865-673-8059
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW31171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical