Healthcare Provider Details

I. General information

NPI: 1891503876
Provider Name (Legal Business Name): WEST TN FAMILY & CRISIS SERVICES CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 BERCLAIR RD APT 8
MEMPHIS TN
38122-5404
US

IV. Provider business mailing address

116 AGNES RD STE 200
KNOXVILLE TN
37919-6306
US

V. Phone/Fax

Practice location:
  • Phone: 901-206-6250
  • Fax:
Mailing address:
  • Phone: 901-206-6250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SP0812X
TaxonomyCommunity Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: PROF. ADRIAN DEWAYNE SOLOMON
Title or Position: CEO-CLINICAL FORENSIC SOCIAL WORKER
Credential: LCSW,MSSW, MHRT
Phone: 901-206-6250