Provider Demographics
NPI:1093169443
Name:EVIDENCE BASED ADDICTION MEDICINE
Entity Type:Organization
Organization Name:EVIDENCE BASED ADDICTION MEDICINE
Other - Org Name:HIGH POINT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:IRICK
Authorized Official - Suffix:
Authorized Official - Credentials:M ED
Authorized Official - Phone:423-631-0731
Mailing Address - Street 1:205 HIGH POINT DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-1503
Mailing Address - Country:US
Mailing Address - Phone:423-631-0731
Mailing Address - Fax:423-631-0732
Practice Address - Street 1:205 HIGH POINT DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-1503
Practice Address - Country:US
Practice Address - Phone:423-631-0731
Practice Address - Fax:423-631-0732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center