Individual
MR. DENNIS HARLEY THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
CORNER OF SIDNEY AND LAMONT ST, JAMES H. QUILLEN VAMC, MOUNTAIN HOME, TN 37684
(423) 979-2872
(423) 979-2812
Mailing address
209 GINGER CT, JOHNSON CITY, TN 37601-6005
(423) 979-2872
(423) 979-2872
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C004994
NC
Other
Enumeration date
07/25/2006
Last updated
07/08/2007
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