Provider Demographics
NPI:1801895305
Name:MAXEY, DAVID JOEL (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DAVID
Middle Name:JOEL
Last Name:MAXEY
Suffix:
Gender:M
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:PO BOX 5558
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37928-0558
Mailing Address - Country:US
Mailing Address - Phone:865-804-4479
Mailing Address - Fax:865-687-7911
Practice Address - Street 1:4741 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-1793
Practice Address - Country:US
Practice Address - Phone:865-804-4479
Practice Address - Fax:865-687-7911
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW38011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3924830Medicaid
39248230Medicare UPIN