Provider Demographics
NPI:1609822170
Name:TOLLISON, PEGGY E (LCSW BCD)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:E
Last Name:TOLLISON
Suffix:
Gender:F
Credentials:LCSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804
Mailing Address - Country:US
Mailing Address - Phone:865-681-2869
Mailing Address - Fax:865-379-2869
Practice Address - Street 1:307 HIGH ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804
Practice Address - Country:US
Practice Address - Phone:865-681-2869
Practice Address - Fax:865-379-2869
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3921418Medicaid
TN132681OtherTRICARE
TN132681OtherTRICARE