| NPI | 1184001869 | 
|---|---|
| Entity Type | Organization | 
| Authorized Contact | DEENA OLIVAS Office Manager 423-708-8670  | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN 38569)  | 
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TN 4744)  | 
| Enumeration Date | 2015-05-01 | 
| Last Update Date | 2024-03-04 |