Provider Demographics
NPI:1295330306
Name:CHITTUM, MIRANDA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:
Last Name:CHITTUM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:MIRANDA
Other - Middle Name:
Other - Last Name:CANTWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:6121 EVENING STAR LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-5261
Mailing Address - Country:US
Mailing Address - Phone:423-736-4351
Mailing Address - Fax:
Practice Address - Street 1:309 N HOUSTON ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-4733
Practice Address - Country:US
Practice Address - Phone:865-268-9144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker