Healthcare Provider Details

I. General information

NPI: 1508035999
Provider Name (Legal Business Name): CHRISTIAN FAMILY SOLUTIONS OF THE MID-SOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 07/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 POPLAR VIEW LANE WEST
COLLIERVILLE TN
38017
US

IV. Provider business mailing address

9160 HIGHWAY 64 SUITE 12, PMB 124
LAKELAND TN
38002-4766
US

V. Phone/Fax

Practice location:
  • Phone: 901-827-3404
  • Fax: 901-234-0113
Mailing address:
  • Phone: 901-827-3404
  • Fax: 901-827-3404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLSW0000003116
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. DAVID GREENHILL WILLIAMS JR.
Title or Position: OWNER
Credential: LCSW
Phone: 901-827-3404