Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003102971 |
---|---|
Provider Name | Amanda Henry |
First Address | Knoxville, TN 37917-5158 |
Second Address | Knoxville, TN 37917-5158 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2011 |
Last Update Date | 20/06/2011 |