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Addiction Substance Use Disorder

Maryville, Tennessee

Provider NPI: 1639148430

Provider Information:
Gender: F
Sole Proprietor

Practice Location:
Tel: 865-386-4642  Fax: 865-379-2869

Business Mailing Address:
Tel: 865-386-4642  Fax: 865-379-2869

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
N101YA0400XBehavioral Health & Social Service Providers
Addiction (Substance Use Disorder)
Y1041C0700XBehavioral Health & Social Service Providers
Social Worker

Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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