Healthcare Provider Details

I. General information

NPI: 1831521467
Provider Name (Legal Business Name): CENTER FOR PROFESSIONAL EXCELLENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 GRASSMERE PARK SUITE 11
NASHVILLE TN
37211-3662
US

IV. Provider business mailing address

624 GRASSMERE PARK SUITE 11
NASHVILLE TN
37211-3662
US

V. Phone/Fax

Practice location:
  • Phone: 615-837-2282
  • Fax: 615-837-0728
Mailing address:
  • Phone: 615-837-2282
  • Fax: 615-837-0728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberL000000013121
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberL000000013121
License Number StateTN

VIII. Authorized Official

Name: DR. DAVID T DODD
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD., LPC
Phone: 615-837-2282