Provider Demographics
NPI:1699757013
Name:FITZSIMMONS, ELDORA L (LCSW)
Entity type:Individual
Prefix:
First Name:ELDORA
Middle Name:L
Last Name:FITZSIMMONS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27183
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37927-7183
Mailing Address - Country:US
Mailing Address - Phone:865-523-4818
Mailing Address - Fax:865-774-4235
Practice Address - Street 1:1031 ELEANOR ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-6641
Practice Address - Country:US
Practice Address - Phone:865-607-1031
Practice Address - Fax:865-523-4818
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-20
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000033841041C0700X
NCC0048291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN249179OtherCOMPSYCH
TN003034281OtherBLUECROSSBLUESHEILD TN
NC138M5OtherBCBS OF NC
NC154785OtherVALUE OPTIONS
NC95920OtherUNITED BEHAVIORAL HEALTH
TN95920OtherUNITED BEHAVIORAL HEALTH
NC245841OtherMHN
TN245841OtherMHN
NC95920OtherUNITED BEHAVIORAL HEALTH