Provider Demographics
NPI:1568562304
Name:HITCHCOCK, ELLEN L (LCSW)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:L
Last Name:HITCHCOCK
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 6606
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37831-3637
Mailing Address - Country:US
Mailing Address - Phone:865-482-9252
Mailing Address - Fax:865-482-7164
Practice Address - Street 1:685 EMORY VALLEY RD # C
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-7746
Practice Address - Country:US
Practice Address - Phone:865-482-9252
Practice Address - Fax:865-482-6265
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000032141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3695396Medicare ID - Type Unspecified