Provider Demographics
NPI:1720395213
Name:ZIMMERMAN, GLENDA DIANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:DIANNE
Last Name:ZIMMERMAN
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 1:3967 GRAHAMDALE CIR
Mailing Address - Street 2:#A
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38122-2301
Mailing Address - Country:US
Mailing Address - Phone:901-628-3060
Mailing Address - Fax:
Practice Address - Street 1:58 TIMBER CREEK DR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4233
Practice Address - Country:US
Practice Address - Phone:901-566-1002
Practice Address - Fax:901-566-1951
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2010-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical