Provider Demographics
NPI:1912275512
Name:COLLINS, JESSICA LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:CATHEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 31569
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37930-1569
Mailing Address - Country:US
Mailing Address - Phone:865-212-6600
Mailing Address - Fax:865-313-2149
Practice Address - Street 1:162 MARKET PLACE BLVD STE D
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-2337
Practice Address - Country:US
Practice Address - Phone:865-212-6600
Practice Address - Fax:865-313-2149
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN61141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103360721Medicaid