Provider Demographics
NPI:1053449348
Name:WORK, CONNIE MALOE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:MALOE
Last Name:WORK
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 1:1510 OLD ESTILL SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-5503
Mailing Address - Country:US
Mailing Address - Phone:931-454-0652
Mailing Address - Fax:
Practice Address - Street 1:2241 THORNTON TAYLOR PKWY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-3637
Practice Address - Country:US
Practice Address - Phone:931-433-6456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4737OtherLICENSE NUMBER