Provider Demographics
NPI:1447669684
Name:UDOM, DEBRAH (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DEBRAH
Middle Name:
Last Name:UDOM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:DEBRAH
Other - Middle Name:SUE
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMSW
Mailing Address - Street 1:2405 FOXCROFT RD
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-5305
Mailing Address - Country:US
Mailing Address - Phone:615-631-5319
Mailing Address - Fax:
Practice Address - Street 1:1450 BATTLEGROUND DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-1750
Practice Address - Country:US
Practice Address - Phone:615-904-7170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000040941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical