Organization
RIVENDELL CENTER LLC
Active
Organization
RIVENDELL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRICIA L GALLAGHER LCSW (OWNER MANAGER)
(865) 681-4914
Entity
Organization
Contact information
Practice address
216 FAIRVIEW DR, MARYVILLE, TN 37803-0537
(865) 681-4914
(865) 977-9573
Mailing address
120 WILSON AVE, MARYVILLE, TN 37803-6051
(865) 681-4914
(865) 977-9573
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LSW0000003963
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3922162
—
TN
Enumeration date
08/05/2006
Last updated
10/04/2007
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