Provider Demographics
NPI:1780789289
Name:NASH, DEBRA SUSAN (LCSW)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:SUSAN
Last Name:NASH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:SUSAN
Other - Last Name:TIMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:386 CARRIAGE HOUSE DR STE E
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2236
Mailing Address - Country:US
Mailing Address - Phone:731-217-9340
Mailing Address - Fax:
Practice Address - Street 1:621 OLD HICKORY BLVD STE E
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2911
Practice Address - Country:US
Practice Address - Phone:731-660-6402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000039051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1506439Medicaid
TN1506439Medicaid