Individual
DAWN M FORTICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
194 MARKET PLACE BLVD, KNOXVILLE, TN 37922
(865) 212-6600
(865) 313-2149
Mailing address
PO BOX 31569, KNOXVILLE, TN 37930-1569
(865) 212-6600
(865) 313-2149
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LSW0000004990
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1533131
—
TN
Enumeration date
07/10/2013
Last updated
01/31/2019
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