Provider Demographics
NPI:1265504468
Name:ORR, LANDRA MARKS (LCSW)
Entity Type:Individual
Prefix:
First Name:LANDRA
Middle Name:MARKS
Last Name:ORR
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 1:101 GRISWOLD CT
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-5281
Mailing Address - Country:US
Mailing Address - Phone:613-319-3943
Mailing Address - Fax:
Practice Address - Street 1:98 MAYFIELD DR STE C
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-3035
Practice Address - Country:US
Practice Address - Phone:615-319-3943
Practice Address - Fax:615-461-8413
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4056237OtherBLUE CROSS BLUE SHIELD
TN3927403Medicare ID - Type Unspecified