Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | 6802087755 | MI |
N | 1041C0700X | Clinical Social Worker | 6802087755 | MI |
NPI | 1003219528 |
---|---|
Provider Name | Susan Peachey Smith |
First Address | Knoxville, TN 37917-5158 |
Second Address | Chattanooga, TN 37404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2014 |
Last Update Date | 06/09/2018 |