Provider Demographics
NPI:1407870991
Name:NELLUMS, VICTORIA (LCSW BCD SAP)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:
Last Name:NELLUMS
Suffix:
Gender:F
Credentials:LCSW BCD SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PBX 10246
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37939
Mailing Address - Country:US
Mailing Address - Phone:865-214-7877
Mailing Address - Fax:
Practice Address - Street 1:901 OAK RIDGE TPKE STE 31
Practice Address - Street 2:THE TUNNELL BLDG
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-8800
Practice Address - Country:US
Practice Address - Phone:865-214-7877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0128270OtherBLUE CROSS
TN3690942Medicaid
TN0128270OtherBLUE CROSS