Provider Demographics
NPI:1699875104
Name:MCCOLL, ELIZABETH S (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:S
Last Name:MCCOLL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4619 CHAMBLISS AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5119
Mailing Address - Country:US
Mailing Address - Phone:865-659-6631
Mailing Address - Fax:865-558-3495
Practice Address - Street 1:4619 CHAMBLISS AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5119
Practice Address - Country:US
Practice Address - Phone:865-659-6631
Practice Address - Fax:865-558-3495
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0103968OtherBCBS
TN3989856Medicaid
TN3989856Medicare ID - Type Unspecified