Provider Demographics
NPI:1801263397
Name:MAINORD, ANGELA DIANE (LMSW)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:DIANE
Last Name:MAINORD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:301 S PERIMETER PARK DR STE 210
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1365 MALEY HOLLOW RD
Practice Address - Street 2:SUITE B
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-6030
Practice Address - Country:US
Practice Address - Phone:865-525-0391
Practice Address - Fax:865-525-0393
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000010301104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker