Provider Demographics
NPI:1619681202
Name:DAVENPORT, HOLLIE STEWART (LCSW)
Entity type:Individual
Prefix:
First Name:HOLLIE
Middle Name:STEWART
Last Name:DAVENPORT
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:PO BOX 6000
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684-6000
Mailing Address - Country:US
Mailing Address - Phone:423-926-1171
Mailing Address - Fax:423-979-2645
Practice Address - Street 1:CORNER OF LAMONT & VETERANS WAY
Practice Address - Street 2:BUILDING 160
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684-6000
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:423-979-2645
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN71421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical