Individual
DR. LONNIE DALE PENROD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, MSW, D.MIN, LCSW
Contact information
Practice address
109 ROOSTER ST, INDIAN MOUND, TN 37079-5302
(931) 980-4551
Mailing address
109 ROOSTER ST, INDIAN MOUND, TN 37079-5302
(931) 980-4551
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6195
TN
Other
Enumeration date
04/19/2021
Last updated
04/19/2021
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