Provider Demographics
NPI:1902176225
Name:MANSUR, JOANNA BETH (LCSW)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:BETH
Last Name:MANSUR
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 1:1214 TOPSIDE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37777-5505
Mailing Address - Country:US
Mailing Address - Phone:865-919-2154
Mailing Address - Fax:
Practice Address - Street 1:1214 TOPSIDE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:TN
Practice Address - Zip Code:37777-5505
Practice Address - Country:US
Practice Address - Phone:865-919-2154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN66831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical