Provider Demographics
NPI:1740328004
Name:SCHWARTZ, SALLYANN (MA LPC MNSP)
Entity type:Individual
Prefix:
First Name:SALLYANN
Middle Name:
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:MA LPC MNSP
Other - Prefix:
Other - First Name:SALLYANN
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3696
Practice Address - Street 1:1570 WAVERLY RD
Practice Address - Street 2:HOLSTON COUNSELING CENTER
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664
Practice Address - Country:US
Practice Address - Phone:423-224-1300
Practice Address - Fax:423-224-1321
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC 1762101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor