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General NPI Number Information
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NPI Number | 1417344763
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Entity Type | Individual
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Provider Name | HEATHER CUPP LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/23/2015
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Last Update Date | 01/31/2020
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Provider Practice Location Address
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Address Line | 723 EMORY VALLEY ROAD
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City | OAK RIDGE
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State | TN
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Zip | 37830
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Country | US
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Telephone | 419-367-5926
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Fax |
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Provider Business Mailing Address
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Address Line | 7735 VILLAGE DR
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City | KNOXVILLE
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State | TN
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Zip | 37919-4724
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Country | US
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Telephone | 419-367-5926
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | S 1500121
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LSW0000010112
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License Number State | TN
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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 | 7022
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License Number State | TN
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