Provider Demographics
NPI:1043314255
Name:HIGHTOWER, BETTY PETKOFF (LCSW)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:PETKOFF
Last Name:HIGHTOWER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:PETKOFF
Other - Last Name:HIGHTOWER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1513 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3808
Mailing Address - Country:US
Mailing Address - Phone:901-725-5331
Mailing Address - Fax:
Practice Address - Street 1:1030 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2127
Practice Address - Country:US
Practice Address - Phone:901-523-8990
Practice Address - Fax:901-577-7449
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1117104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker