Provider Demographics
NPI:1013882810
Name:MELLINGER, JACQUELINE (MA, NCC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:MELLINGER
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:HOMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3624 VANDEVENTER AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4578
Mailing Address - Country:US
Mailing Address - Phone:865-226-9037
Mailing Address - Fax:
Practice Address - Street 1:3624 VANDEVENTER AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4578
Practice Address - Country:US
Practice Address - Phone:865-226-9037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health