Provider Demographics
NPI:1790176667
Name:KINGSPORT PSYCHIATRY & COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:KINGSPORT PSYCHIATRY & COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SACHDEV
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMIAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-245-2406
Mailing Address - Street 1:1401 BRIDGEWATER LN
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4164
Mailing Address - Country:US
Mailing Address - Phone:423-245-2406
Mailing Address - Fax:423-245-2404
Practice Address - Street 1:1401 BRIDGEWATER LN
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4164
Practice Address - Country:US
Practice Address - Phone:423-245-2406
Practice Address - Fax:423-245-2404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TNMD394102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty