Provider Demographics
NPI:1881054625
Name:LONGMIRE, NAKEESHA (LCSW)
Entity type:Individual
Prefix:
First Name:NAKEESHA
Middle Name:
Last Name:LONGMIRE
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 1:1331 UNION AVE
Mailing Address - Street 2:STE 1024
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-7509
Mailing Address - Country:US
Mailing Address - Phone:901-833-7095
Mailing Address - Fax:
Practice Address - Street 1:1698 BELLEDEER DR E
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-0428
Practice Address - Country:US
Practice Address - Phone:901-292-6928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10786104100000X
TN67641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6764OtherSTATE OF TENNESSEE