Provider Demographics
NPI:1427247535
Name:MEDICUS, KATHARINE KELLIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KATHARINE
Middle Name:KELLIE
Last Name:MEDICUS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:KELLIE
Other - Last Name:FRANCIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMSW
Mailing Address - Street 1:234 E OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-6332
Mailing Address - Country:US
Mailing Address - Phone:865-637-6793
Mailing Address - Fax:
Practice Address - Street 1:428 E SCOTT AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-6362
Practice Address - Country:US
Practice Address - Phone:865-621-7644
Practice Address - Fax:865-329-9433
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical