Provider Demographics
NPI:1871542068
Name:IDOL, ENOCH COLVIN
Entity type:Individual
Prefix:MR
First Name:ENOCH
Middle Name:COLVIN
Last Name:IDOL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ENOCH
Other - Middle Name:COLVIN
Other - Last Name:IDOL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, NCC
Mailing Address - Street 1:3105 ESSARY DRIVE
Mailing Address - Street 2:ALTERNATIVE COUNSELING CENTER
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-2409
Mailing Address - Country:US
Mailing Address - Phone:865-687-8990
Mailing Address - Fax:865-687-1190
Practice Address - Street 1:3105 ESSARY DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-2409
Practice Address - Country:US
Practice Address - Phone:865-687-8990
Practice Address - Fax:865-687-1190
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2315101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health