Organization
DIVINE SOURCE
Active
Other names
Divine Source
Organization subpart
No
Provider details
NPI number
Authorized official
BARBARA M GILLAM LCSW (LICENSED CLINICAL SOCIAL WORK)
(615) 428-4425
Entity
Organization
Contact information
Practice address
141 COUNTRY CLUB DR, HENDERSONVILLE, TN 37075-4041
(615) 428-4425
Mailing address
141 COUNTRY CLUB DR, HENDERSONVILLE, TN 37075-4041
(615) 428-4425
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
06/16/2020
Last updated
06/16/2020
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