Provider Demographics
NPI:1104997337
Name:DORRIS, RACHEL BRIMM (LCSW)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:BRIMM
Last Name:DORRIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 E BROADWAY STE 12
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-4613
Mailing Address - Country:US
Mailing Address - Phone:615-451-0250
Mailing Address - Fax:615-451-0240
Practice Address - Street 1:150 N. MAIN ST.
Practice Address - Street 2:SUITE 303
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-3251
Practice Address - Country:US
Practice Address - Phone:615-451-0250
Practice Address - Fax:615-451-0240
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3920092Medicaid
TN1568647105OtherGROUP NPI