Individual
MRS. CYNTHIA DAWN KETRON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3218 DUTCHESS DR, KINGSPORT, TN 37663-2904
(423) 239-5912
Mailing address
3218 DUTCHESS DR, KINGSPORT, TN 37663-2904
(423) 239-5912
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LSW0000003148
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LSW0000003148
LCSW
TN
Enumeration date
04/11/2007
Last updated
01/21/2008
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