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General NPI Number Information
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NPI Number | 1417230608
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Entity Type | Organization
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Legal Business Name | HEALING TRAUMA
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Dates
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Enumeration Date | 09/23/2011
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Last Update Date | 09/23/2011
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Provider Practice Location Address
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Address Line | 108 W SUMMIT HILL DR
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City | KNOXVILLE
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State | TN
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Zip | 37902-1025
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Country | US
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Telephone | 865-250-0728
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Fax |
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Provider Business Mailing Address
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Address Line | 7338 JENKINS CREEK DR
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City | KNOXVILLE
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State | TN
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Zip | 37931-4563
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Country | US
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Telephone | 865-250-0728
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. IRINA V DIYANKOVA
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Credential | PH.D.
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Telephone | 865-250-0728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | P0000002869
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License Number State | TN
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