Provider Demographics
NPI:1255469227
Name:CENTERSTONE
Entity Type:Organization
Organization Name:CENTERSTONE
Other - Org Name:MENTAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:HIGHFIELD
Authorized Official - Suffix:SR
Authorized Official - Credentials:MDIV
Authorized Official - Phone:931-729-3573
Mailing Address - Street 1:704 HIGHWAY 100
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CENTERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37033
Mailing Address - Country:US
Mailing Address - Phone:931-729-3573
Mailing Address - Fax:931-729-9330
Practice Address - Street 1:704 HIGHWAY 100
Practice Address - Street 2:SUITE 101
Practice Address - City:CENTERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37033
Practice Address - Country:US
Practice Address - Phone:931-729-3573
Practice Address - Fax:931-729-9330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDC00000000235251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable