Healthcare Provider Details

I. General information

NPI: 1033216304
Provider Name (Legal Business Name): SEXUAL ASSAULT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 FRENCH LANDING DR
NASHVILLE TN
37228-1511
US

IV. Provider business mailing address

101 FRENCH LANDING DR
NASHVILLE TN
37228-1511
US

V. Phone/Fax

Practice location:
  • Phone: 615-259-9055
  • Fax: 615-244-6855
Mailing address:
  • Phone: 615-259-9055
  • Fax: 615-244-6855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateTN

VIII. Authorized Official

Name: MS. PAM N PENUEL
Title or Position: BILLING DIRECTOR
Credential:
Phone: 615-259-9055