Provider Demographics
NPI:1235334350
Name:DUNAWAY, MARCELLA HORN (PHD)
Entity Type:Individual
Prefix:
First Name:MARCELLA
Middle Name:HORN
Last Name:DUNAWAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MARCELLA
Other - Middle Name:RUTH
Other - Last Name:HORN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4068
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37802-4068
Mailing Address - Country:US
Mailing Address - Phone:865-273-1752
Mailing Address - Fax:865-273-1755
Practice Address - Street 1:262 CHEROKEE PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5153
Practice Address - Country:US
Practice Address - Phone:865-984-4223
Practice Address - Fax:865-681-1789
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP2872 (PROV)103TC0700X
TNP2872103TC0700X, 103TC2200X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1517021Medicaid
TN1035I05899Medicare PIN