Provider Demographics
NPI:1346728870
Name:PRISCILLA PERRY CENTER
Entity Type:Organization
Organization Name:PRISCILLA PERRY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TYNEISIA
Authorized Official - Middle Name:CHRISCYNTHIA
Authorized Official - Last Name:HERNDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-670-2598
Mailing Address - Street 1:3806 CARLYLE PL
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-6594
Mailing Address - Country:US
Mailing Address - Phone:704-670-2598
Mailing Address - Fax:
Practice Address - Street 1:3806 CARLYLE PL
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-6594
Practice Address - Country:US
Practice Address - Phone:704-670-2598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6532251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health