Provider Demographics
NPI:1063919504
Name:BROGDON, KAREN (LADAC II)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BROGDON
Suffix:
Gender:
Credentials:LADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 BROOME RD APT 16F
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-2617
Mailing Address - Country:US
Mailing Address - Phone:865-316-4918
Mailing Address - Fax:
Practice Address - Street 1:3006 LAKE BROOK BLVD BLDG 1
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1137
Practice Address - Country:US
Practice Address - Phone:865-637-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1553101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)