Provider Demographics
NPI:1306089586
Name:JOLLY, KARNILLA ANNE (LCSW)
Entity type:Individual
Prefix:
First Name:KARNILLA
Middle Name:ANNE
Last Name:JOLLY
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 1:184 WORTHEY LN
Mailing Address - Street 2:
Mailing Address - City:WARD
Mailing Address - State:AR
Mailing Address - Zip Code:72176-7772
Mailing Address - Country:US
Mailing Address - Phone:501-288-0820
Mailing Address - Fax:
Practice Address - Street 1:3022 VANDERBILT PL
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2500
Practice Address - Country:US
Practice Address - Phone:615-393-3792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5555-C1041C0700X
ARP0806047101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR176345795Medicaid
AR5AB95OtherBCBS
AR5AB95OtherBCBS