Provider Demographics
NPI:1811593460
Name:PELLEY, ADOLPHUS HAYWARD (ED)
Entity Type:Individual
Prefix:DR
First Name:ADOLPHUS
Middle Name:HAYWARD
Last Name:PELLEY
Suffix:
Gender:M
Credentials:ED
Other - Prefix:
Other - First Name:DICK
Other - Middle Name:
Other - Last Name:PELLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:201 W SPRINGDALE AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-5158
Mailing Address - Country:US
Mailing Address - Phone:865-637-9711
Mailing Address - Fax:
Practice Address - Street 1:2336 CONGRESS PKWY S
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-2820
Practice Address - Country:US
Practice Address - Phone:423-266-6751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor