Individual
MR. MICHAEL TIMOTHY GARDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
5410 HOMBERG DR, SUITE 14, KNOXVILLE, TN 37919-5031
(865) 588-3178
Mailing address
6937 SICILIA LN, CORRYTON, TN 37721-3538
(865) 399-4033
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LSW0000004287
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LSW0000004287
LICENSED CLINICAL SOCIAL WORKER
TN
Enumeration date
02/13/2012
Last updated
02/13/2012
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