Provider Demographics
NPI:1629741129
Name:COLLABORATIVE COUNSELING
Entity type:Organization
Organization Name:COLLABORATIVE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:STOVER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:865-258-7053
Mailing Address - Street 1:1361 PERKINS ST
Mailing Address - Street 2:
Mailing Address - City:ALCOA
Mailing Address - State:TN
Mailing Address - Zip Code:37701-2354
Mailing Address - Country:US
Mailing Address - Phone:865-258-7053
Mailing Address - Fax:
Practice Address - Street 1:1361 PERKINS ST
Practice Address - Street 2:
Practice Address - City:ALCOA
Practice Address - State:TN
Practice Address - Zip Code:37701-2354
Practice Address - Country:US
Practice Address - Phone:865-258-7053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-29
Last Update Date:2024-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ068098Medicaid