Healthcare Provider Details

I. General information

NPI: 1467127571
Provider Name (Legal Business Name): CHELSEY COLLEA LCSW, CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SIDNEY AND LAMONT STREET
MOUNTAIN HOME TN
37684
US

IV. Provider business mailing address

PO BOX 4000
MOUNTAIN HOME TN
37684-4000
US

V. Phone/Fax

Practice location:
  • Phone: 423-926-1171
  • Fax:
Mailing address:
  • Phone: 423-926-1171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10063
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: