Provider Demographics
NPI:1457190571
Name:REAL TALK LLC
Entity type:Organization
Organization Name:REAL TALK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:SCRAGGS
Authorized Official - Last Name:LMSW
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:865-228-5555
Mailing Address - Street 1:5710 JACKSBORO PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-4120
Mailing Address - Country:US
Mailing Address - Phone:865-228-5555
Mailing Address - Fax:
Practice Address - Street 1:5710 JACKSBORO PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-4120
Practice Address - Country:US
Practice Address - Phone:865-228-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health