Provider Demographics
NPI:1154876746
Name:MICKLES, JOAN STEWART (NCC)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:STEWART
Last Name:MICKLES
Suffix:
Gender:F
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 FAIRHILLS DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-4324
Mailing Address - Country:US
Mailing Address - Phone:423-994-3788
Mailing Address - Fax:
Practice Address - Street 1:9 FAIRHILLS DRIVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405
Practice Address - Country:US
Practice Address - Phone:423-994-3788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health