Provider Demographics
NPI:1326158999
Name:KOVAC, JEANNA LEE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:JEANNA
Middle Name:LEE
Last Name:KOVAC
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MRS
Other - First Name:JEANNA
Other - Middle Name:LEE
Other - Last Name:TROIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:111 E. COLLEGE ST.
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659
Mailing Address - Country:US
Mailing Address - Phone:423-737-3919
Mailing Address - Fax:
Practice Address - Street 1:117 1/2 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659
Practice Address - Country:US
Practice Address - Phone:423-737-3919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1162221041C0700X
RIISW020241041C0700X
TN78991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical