Provider Demographics
NPI:1548819279
Name:MAYES, IVORIE NICOLE (MSW)
Entity type:Individual
Prefix:MRS
First Name:IVORIE
Middle Name:NICOLE
Last Name:MAYES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:IVORIE
Other - Middle Name:NICOLE
Other - Last Name:MAYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IVORIE FRAZIER
Mailing Address - Street 1:200 TECH CENTER DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37912-2747
Mailing Address - Country:US
Mailing Address - Phone:865-637-9711
Mailing Address - Fax:
Practice Address - Street 1:1510 RINGGOLD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-5444
Practice Address - Country:US
Practice Address - Phone:423-531-2894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health