Healthcare Provider Details

I. General information

NPI: 1760816565
Provider Name (Legal Business Name): CDS VENTURES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 W MAIN ST STE 902
LEBANON TN
37087-7800
US

IV. Provider business mailing address

1633 W MAIN ST STE 902
LEBANON TN
37087-7800
US

V. Phone/Fax

Practice location:
  • Phone: 615-220-6005
  • Fax:
Mailing address:
  • Phone: 615-220-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3001
License Number StateTN

VIII. Authorized Official

Name: DR. DAWN-ELISE SNIPES
Title or Position: CEO
Credential: PHD LPC-MHSP, LMHC
Phone: 615-220-6005