Provider Demographics
NPI:1083287072
Name:PAYNE, TERESA JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:JEAN
Last Name:PAYNE
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 1:716 WAMPUM DR
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38572-7605
Mailing Address - Country:US
Mailing Address - Phone:615-232-4250
Mailing Address - Fax:
Practice Address - Street 1:716 WAMPUM DR
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38572-7605
Practice Address - Country:US
Practice Address - Phone:615-232-4250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8823104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker