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General NPI Number Information
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NPI Number | 1669866851
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Entity Type | Organization
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Legal Business Name | SOUL HOSPITAL WITH DR. CHAR
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Dates
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Enumeration Date | 03/25/2015
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Last Update Date | 03/25/2015
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Provider Practice Location Address
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Address Line | 1416 BREDA DR
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City | KNOXVILLE
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State | TN
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Zip | 37918-1401
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Country | US
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Telephone | 865-806-4403
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Fax |
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Provider Business Mailing Address
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Address Line | 1416 BREDA DR PO BOX 5450
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City | KNOXVILLE
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State | TN
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Zip | 37918-1401
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Country | US
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Telephone | 865-806-4403
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLOTTE ANN FRYE
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Credential | LMHC, LPC-MHSP
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Telephone | 865-806-4403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 3163
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License Number State | TN
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