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General NPI Number Information
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NPI Number | 1093169443
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Entity Type | Organization
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Legal Business Name | EVIDENCE BASED ADDICTION MEDICINE
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Dates
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Enumeration Date | 04/21/2016
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Last Update Date | 04/21/2016
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Provider Practice Location Address
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Address Line | 205 HIGH POINT DR
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City | JOHNSON CITY
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State | TN
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Zip | 37601-1503
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Country | US
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Telephone | 423-631-0731
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Fax | 423-631-0732
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Provider Business Mailing Address
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Address Line | 205 HIGH POINT DR
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City | JOHNSON CITY
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State | TN
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Zip | 37601-1503
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Country | US
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Telephone | 423-631-0731
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Fax | 423-631-0732
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. DEANNA LYNN IRICK
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Credential | M. ED.
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Telephone | 423-631-0731
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | TN
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