Provider Demographics
NPI:1619040813
Name:VANDERBILT COMMUNITY MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:VANDERBILT COMMUNITY MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:GENORRIS
Authorized Official - Middle Name:LATRISE
Authorized Official - Last Name:CRAWFORD-CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:615-532-2052
Mailing Address - Street 1:2408 14TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-1164
Mailing Address - Country:US
Mailing Address - Phone:615-244-8066
Mailing Address - Fax:
Practice Address - Street 1:1601 23RD AVE S
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-3133
Practice Address - Country:US
Practice Address - Phone:615-532-2052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital