Provider Demographics
NPI:1396709960
Name:CITTY, NANCY BLAYLOCK (LCSW)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:BLAYLOCK
Last Name:CITTY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:E
Other - Last Name:BLAYLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4000 ABERCORN RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37921-5235
Mailing Address - Country:US
Mailing Address - Phone:865-405-6809
Mailing Address - Fax:
Practice Address - Street 1:118 WESTFIELD RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919
Practice Address - Country:US
Practice Address - Phone:865-405-6809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3694317Medicaid
TNQ036849Medicaid