Provider Demographics
NPI:1053578419
Name:GATTIS, VICTORIA T (LCSW)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:T
Last Name:GATTIS
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 1:491 HILLVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-1213
Mailing Address - Country:US
Mailing Address - Phone:931-766-8549
Mailing Address - Fax:931-766-8549
Practice Address - Street 1:491 HILLVIEW DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-1213
Practice Address - Country:US
Practice Address - Phone:931-766-8549
Practice Address - Fax:931-766-8549
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4936101YM0800X
TNLSW00000049361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3278660OtherMEDICARE GROUP/ORGANIZATION PTAN
TN3920128OtherMEDICARE INDIVIDUAL PTAN
TN3920128OtherMEDICARE INDIVIDUAL PTAN