Healthcare Provider Details

I. General information

NPI: 1851499537
Provider Name (Legal Business Name): ANGELA L. MOBLEY-MCCOY MA, LSPE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 ALCOA HWY STE 435 BLDG A
KNOXVILLE TN
37920-1520
US

IV. Provider business mailing address

1937 BELCARO DR
KNOXVILLE TN
37918-3709
US

V. Phone/Fax

Practice location:
  • Phone: 865-544-9030
  • Fax: 865-544-6675
Mailing address:
  • Phone: 865-689-6744
  • Fax: 865-689-6744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPE0000001547
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: