Provider Demographics
NPI:1215233937
Name:BOONE, CAROL MARIE (LCSW)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:MARIE
Last Name:BOONE
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 1:320 CHICKASAW TRL
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3302
Mailing Address - Country:US
Mailing Address - Phone:615-851-1527
Mailing Address - Fax:615-727-6291
Practice Address - Street 1:1160 GALLATIN PIKE S
Practice Address - Street 2:SUITE 214
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-4624
Practice Address - Country:US
Practice Address - Phone:615-851-1527
Practice Address - Fax:615-727-6291
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000012411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I804429Medicare PIN