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General NPI Number Information
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NPI Number | 1063934966
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Entity Type | Organization
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Legal Business Name | SOBER LIVING OF TENNESSEE, INC
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Dates
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Enumeration Date | 07/12/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 402 S COLLEGE ST
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City | SMITHVILLE
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State | TN
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Zip | 37166-1900
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Country | US
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Telephone | 931-979-5158
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Fax |
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Provider Business Mailing Address
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Address Line | 269 W HUNT RD
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City | ALCOA
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State | TN
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Zip | 37701-1724
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Country | US
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Telephone | 931-979-5158
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Fax |
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Authorized Official
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Title or Position | COMPLIANCE OFFICER
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Name | JAMES STUBBLEFIELD
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Credential |
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Telephone | 931-979-5158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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