Provider Demographics
NPI:1477808475
Name:CENTERSTONE OF TENNESSEE
Entity Type:Organization
Organization Name:CENTERSTONE OF TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EARLY CHILDHOOD SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PORCHIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-920-7200
Mailing Address - Street 1:404 PAGEANT LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-3865
Mailing Address - Country:US
Mailing Address - Phone:931-920-7200
Mailing Address - Fax:
Practice Address - Street 1:404 PAGEANT LN
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3865
Practice Address - Country:US
Practice Address - Phone:931-920-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health