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General NPI Number Information
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NPI Number | 1427460278
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Entity Type | Individual
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Provider Name | AYANA LAKULIA CHISM LMSW
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Gender | Female
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Dates
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Enumeration Date | 05/28/2014
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Last Update Date | 05/28/2014
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Provider Practice Location Address
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Address Line | 215 HAWKS RD SUITE 5
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City | MARTIN
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State | TN
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Zip | 38237-2708
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Country | US
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Telephone | 731-587-3545
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Fax | 731-587-3546
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Provider Business Mailing Address
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Address Line | 536 HUTCHENS RD APT A
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City | MARTIN
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State | TN
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Zip | 38237-5228
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Country | US
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Telephone | 731-695-5633
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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 | 8638
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License Number State | TN
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