Provider Demographics
NPI:1265580310
Name:WORRELL, SANDRA SUE (LCSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:SUE
Last Name:WORRELL
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 1:120 3RD AVE S
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-2511
Mailing Address - Country:US
Mailing Address - Phone:615-790-7022
Mailing Address - Fax:615-790-7022
Practice Address - Street 1:120 3RD AVE S
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-2511
Practice Address - Country:US
Practice Address - Phone:615-790-7022
Practice Address - Fax:615-790-7022
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000001190101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN104235OtherVALUE OPTIONS
TN120024OtherHEALTH PARTNERS
TN244168OtherCOMPSYCH
TN38602OtherCIGNA
TN4057817OtherBCBS
TN121261OtherMHN
TN1516374OtherHEALTH SPRING
TN38602OtherCIGNA