Healthcare Provider Details

I. General information

NPI: 1225220700
Provider Name (Legal Business Name): KOINONIA COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3343 DEWINE RD
KNOXVILLE TN
37921-4211
US

IV. Provider business mailing address

3343 DEWINE RD
KNOXVILLE TN
37921-4211
US

V. Phone/Fax

Practice location:
  • Phone: 865-584-6374
  • Fax: 865-584-6613
Mailing address:
  • Phone: 865-584-6374
  • Fax: 865-584-6613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberLPC0812
License Number StateTN

VIII. Authorized Official

Name: DR. CHARLES SANDERFUR
Title or Position: OWNER/THERAPIST
Credential: LPC, M.ED
Phone: 865-584-6374