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General NPI Number Information
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NPI Number | 1053915199
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Entity Type | Organization
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Legal Business Name | TENNESSEE ADDICTION LLC
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Dates
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Enumeration Date | 11/30/2020
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Last Update Date | 03/16/2022
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Provider Practice Location Address
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Address Line | 4820 OLD KINGSTON PIKE STE 100
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City | KNOXVILLE
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State | TN
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Zip | 37919-6424
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Country | US
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Telephone | 865-205-2770
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 440832
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City | KENNESAW
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State | GA
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Zip | 30160-9514
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | SPENCER STEIN
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Credential |
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Telephone | 865-205-2770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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