Provider Demographics
NPI:1851457402
Name:TAYLOR, CONNIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:
Last Name:TAYLOR
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 1:3508 MARYVILLE PIKE
Mailing Address - Street 2:SUITE E
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-6195
Mailing Address - Country:US
Mailing Address - Phone:865-579-5886
Mailing Address - Fax:865-579-5884
Practice Address - Street 1:3508 MARYVILLE PIKE
Practice Address - Street 2:SUITE E
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-6195
Practice Address - Country:US
Practice Address - Phone:865-579-5886
Practice Address - Fax:865-579-5884
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0039091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3922352Medicaid
TN3156670OtherBCBS
TN3922352Medicaid