Individual
GERALDINE FORAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
402 CENTER AVE, DICKSON, TN 37055-2458
(615) 446-2134
Mailing address
1548 E PINEY RD, DICKSON, TN 37055-3849
(615) 446-9410
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6370
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508075
—
TN
Enumeration date
03/17/2016
Last updated
03/17/2016
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