Provider Demographics
NPI:1427458264
Name:FAIR, CARRIE (LCSW)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:FAIR
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 1:3904 HOLSTON HILLS RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37914-6295
Mailing Address - Country:US
Mailing Address - Phone:865-323-2617
Mailing Address - Fax:
Practice Address - Street 1:125 N CONCORD ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-2330
Practice Address - Country:US
Practice Address - Phone:865-323-2617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000057711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical