Provider Demographics
NPI:1417230608
Name:HEALING TRAUMA
Entity Type:Organization
Organization Name:HEALING TRAUMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:V
Authorized Official - Last Name:DIYANKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:865-250-0728
Mailing Address - Street 1:7338 JENKINS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-4563
Mailing Address - Country:US
Mailing Address - Phone:865-250-0728
Mailing Address - Fax:
Practice Address - Street 1:108 W SUMMIT HILL DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37902-1025
Practice Address - Country:US
Practice Address - Phone:865-250-0728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000002869103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty