Provider Demographics
NPI:1770622318
Name:HUFFAKER, GALE DAWSON (LCSW)
Entity type:Individual
Prefix:MS
First Name:GALE
Middle Name:DAWSON
Last Name:HUFFAKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6025 BROOKVALE LANE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4031
Mailing Address - Country:US
Mailing Address - Phone:865-588-6916
Mailing Address - Fax:865-588-7057
Practice Address - Street 1:6025 BROOKVALE LANE
Practice Address - Street 2:SUITE 205
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4031
Practice Address - Country:US
Practice Address - Phone:865-588-6916
Practice Address - Fax:865-588-7057
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000040821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4026739OtherBLUE CROSS BLUE SHIELD TN
6237474OtherUNITED BEHAVIORAL HEALTH
3924589Medicare ID - Type Unspecified