Provider Demographics
NPI:1386201531
Name:CASEVECHIA, MALLORY PAIGE (LPCMHSP)
Entity Type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:PAIGE
Last Name:CASEVECHIA
Suffix:
Gender:F
Credentials:LPCMHSP
Other - Prefix:MS
Other - First Name:MALLORY
Other - Middle Name:
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCMHSP
Mailing Address - Street 1:1112 GALEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-8416
Mailing Address - Country:US
Mailing Address - Phone:865-320-2181
Mailing Address - Fax:
Practice Address - Street 1:9111 CROSS PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4506
Practice Address - Country:US
Practice Address - Phone:865-320-2181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-23
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
TNTN3834101YM0800X, 101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional