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General NPI Number Information
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NPI Number | 1225220700
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Entity Type | Organization
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Legal Business Name | KOINONIA COUNSELING CENTER
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Dates
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Enumeration Date | 08/17/2007
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Last Update Date | 08/17/2007
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Provider Practice Location Address
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Address Line | 3343 DEWINE RD
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City | KNOXVILLE
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State | TN
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Zip | 37921-4211
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Country | US
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Telephone | 865-584-6374
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Fax | 865-584-6613
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Provider Business Mailing Address
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Address Line | 3343 DEWINE RD
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City | KNOXVILLE
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State | TN
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Zip | 37921-4211
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Country | US
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Telephone | 865-584-6374
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Fax | 865-584-6613
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | DR. CHARLES SANDERFUR
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Credential | LPC, M.ED
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Telephone | 865-584-6374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | LPC0812
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License Number State | TN
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