Healthcare Provider Details

I. General information

NPI: 1073053625
Provider Name (Legal Business Name): BOWDOIN RECOVERY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 NISSAN DR STE 202
SMYRNA TN
37167-4365
US

IV. Provider business mailing address

431 NISSAN DR STE 202
SMYRNA TN
37167-4365
US

V. Phone/Fax

Practice location:
  • Phone: 615-462-7392
  • Fax: 615-267-0020
Mailing address:
  • Phone: 615-462-7392
  • Fax: 615-267-0020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberL000000018108
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberL000000018108
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberL000000018108
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberL000000018108
License Number StateTN
# 5
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LUTHER BOWDOIN
Title or Position: CONTROLLER
Credential:
Phone: 615-462-7392