Provider Demographics
NPI:1174838932
Name:SHORT, JANIE ALLENE (LCSW)
Entity Type:Individual
Prefix:
First Name:JANIE
Middle Name:ALLENE
Last Name:SHORT
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 1:306 W HOLSTON AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-5526
Mailing Address - Country:US
Mailing Address - Phone:423-930-4986
Mailing Address - Fax:
Practice Address - Street 1:306 W HOLSTON AVE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-5526
Practice Address - Country:US
Practice Address - Phone:423-930-4986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN52531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical