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General NPI Number Information
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NPI Number | 1144368192
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Entity Type | Individual
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Provider Name | SHUNDA L MCCOY SOCIAL WORKER
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Gender | Female
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 03/15/2024
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Provider Practice Location Address
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Address Line | 1403 EVERGREEN ST
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City | COVINGTON
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State | TN
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Zip | 38019-3201
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Country | US
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Telephone | 901-451-3087
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 784
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City | BRIGHTON
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State | TN
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Zip | 38011-0784
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Country | US
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Telephone | 901-451-3087
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LSW0000007767
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License Number State | TN
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