Healthcare Provider Details

I. General information

NPI: 1285336446
Provider Name (Legal Business Name): RECOVERY SOLDIERS MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 BRISTOL HWY
ELIZABETHTON TN
37643-6684
US

IV. Provider business mailing address

1180 BRISTOL HWY
ELIZABETHTON TN
37643-6684
US

V. Phone/Fax

Practice location:
  • Phone: 423-747-3803
  • Fax:
Mailing address:
  • Phone: 423-747-3803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LINCOLN SHELTON
Title or Position: CLINICAL DIRECTOR
Credential: LPC,MHSP
Phone: 423-747-3803