Healthcare Provider Details

I. General information

NPI: 1144748633
Provider Name (Legal Business Name): ACE AWARENESS FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 09/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 COLLEGE PARK DR STE 140
MEMPHIS TN
38126-6519
US

IV. Provider business mailing address

22 N FRONT ST STE 165
MEMPHIS TN
38103-2196
US

V. Phone/Fax

Practice location:
  • Phone: 901-207-3694
  • Fax:
Mailing address:
  • Phone: 901-249-2459
  • Fax: 901-249-2299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KRYSTAL L ROSS
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 901-249-2456