Provider Demographics
NPI:1215610449
Name:TRITT, JACQUELYN NICHOLE (MSW)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:NICHOLE
Last Name:TRITT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7937 POWELL HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-3804
Mailing Address - Country:US
Mailing Address - Phone:865-556-0636
Mailing Address - Fax:
Practice Address - Street 1:118 MABRY HOOD RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-2219
Practice Address - Country:US
Practice Address - Phone:865-982-5225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical