Provider Demographics
NPI:1346927589
Name:DEDICATED PSYCHIATRIC SERVICES, PLLC
Entity Type:Organization
Organization Name:DEDICATED PSYCHIATRIC SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:423-366-6013
Mailing Address - Street 1:1944 BROOKSIDE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4618
Mailing Address - Country:US
Mailing Address - Phone:423-366-6013
Mailing Address - Fax:
Practice Address - Street 1:1944 BROOKSIDE DR STE 3
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4618
Practice Address - Country:US
Practice Address - Phone:423-366-6013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty