Provider Demographics
NPI:1912975863
Name:PARKINSON, ELLEN G (LCSW)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:G
Last Name:PARKINSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:P
Other - Last Name:GADDIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
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:865-541-6956
Practice Address - Street 1:707 DOLLY PARTON PKWY
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-3961
Practice Address - Country:US
Practice Address - Phone:865-429-0557
Practice Address - Fax:865-429-6886
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3925746Medicare ID - Type Unspecified