Individual
TAMMY R. MOODY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
332 E SPRINGBROOK DR, SUITE 500, JOHNSON CITY, TN 37601-1767
(423) 282-1394
(423) 282-1394
Mailing address
332 E SPRINGBROOK DR, SUITE 500, JOHNSON CITY, TN 37601-1767
(423) 282-1394
(423) 282-1394
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LSW 876
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3927687
—
TN
01
—
4094498
BLUE CROSS BLUE SHIELD
TN
Enumeration date
11/17/2006
Last updated
05/10/2008
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