Healthcare Provider Details

I. General information

NPI: 1447189733
Provider Name (Legal Business Name): COMMUNITY IMPACT COLLECTIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 N LIBERTY ST
JACKSON TN
38301-6221
US

IV. Provider business mailing address

118 N LIBERTY ST
JACKSON TN
38301-6221
US

V. Phone/Fax

Practice location:
  • Phone: 731-313-3155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: TERESA PASLEY
Title or Position: ASSOCIATE DIRECTOR
Credential:
Phone: 731-313-3155