Provider Demographics
NPI:1871625541
Name:OVERTON, CHRISTINE MANGUM (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:MANGUM
Last Name:OVERTON
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 1:856 MIDDLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-5035
Mailing Address - Country:US
Mailing Address - Phone:865-428-2193
Mailing Address - Fax:865-428-2090
Practice Address - Street 1:856 MIDDLE CREEK RD
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-5035
Practice Address - Country:US
Practice Address - Phone:865-428-2193
Practice Address - Fax:865-428-2090
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3699007Medicaid
TN3699007Medicaid