Provider Demographics
NPI:1679926802
Name:ABDOSH, ANISA
Entity Type:Individual
Prefix:
First Name:ANISA
Middle Name:
Last Name:ABDOSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:879 HIGHWAY 126 STE B
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-3308
Mailing Address - Country:US
Mailing Address - Phone:423-930-7408
Mailing Address - Fax:
Practice Address - Street 1:879 HIGHWAY 126 STE B
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-3308
Practice Address - Country:US
Practice Address - Phone:423-930-7408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-23
Last Update Date:2016-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000856717101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health