Healthcare Provider Details

I. General information

NPI: 1104662428
Provider Name (Legal Business Name): DANQUILLA TOWNSEND OWNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2024
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2874 PRICE DR STE 2
BARTLETT TN
38134-4695
US

IV. Provider business mailing address

2874 PRICE DR STE 2
BARTLETT TN
38134-4695
US

V. Phone/Fax

Practice location:
  • Phone: 901-428-2905
  • Fax: 833-829-5135
Mailing address:
  • Phone: 901-428-2905
  • Fax: 833-829-5135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberI000000039646
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberI000000039646
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberI000000039646
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberI000000039646
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: