Provider Demographics
NPI:1861866279
Name:MCCOMAS, JENNIFER SMITH (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SMITH
Last Name:MCCOMAS
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 1:4869 CHAMBLISS AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5122
Mailing Address - Country:US
Mailing Address - Phone:865-742-8094
Mailing Address - Fax:
Practice Address - Street 1:4869 CHAMBLISS AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5122
Practice Address - Country:US
Practice Address - Phone:865-742-8094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-23
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000096071041C0700X
TNLSW00000077051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical