Provider Demographics
NPI:1447873112
Name:CECIL, CORRIE JEAN (LCSW)
Entity type:Individual
Prefix:
First Name:CORRIE
Middle Name:JEAN
Last Name:CECIL
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 1:438 W CAMPBELL RD
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-2908
Mailing Address - Country:US
Mailing Address - Phone:615-557-3572
Mailing Address - Fax:
Practice Address - Street 1:438 W CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2908
Practice Address - Country:US
Practice Address - Phone:615-557-3572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000071281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical