Provider Demographics
NPI:1649240904
Name:ALLSTON, JUDITH A (LCSW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:ALLSTON
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 1:1002 BRADFORD WAY
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-3100
Mailing Address - Country:US
Mailing Address - Phone:865-376-1585
Mailing Address - Fax:865-376-1587
Practice Address - Street 1:1002 BRADFORD WAY
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:TN
Practice Address - Zip Code:37763-3100
Practice Address - Country:US
Practice Address - Phone:865-376-1585
Practice Address - Fax:865-376-1587
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0674104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4045761OtherBLUE CROSS BLUE SHIELD
TN3695617Medicare UPIN
TN4045761OtherBLUE CROSS BLUE SHIELD