Provider Demographics
NPI:1881019255
Name:COFFEE COUNTY DRUG COURT
Entity Type:Organization
Organization Name:COFFEE COUNTY DRUG COURT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-581-3602
Mailing Address - Street 1:604 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-1769
Mailing Address - Country:US
Mailing Address - Phone:931-723-3051
Mailing Address - Fax:931-723-3632
Practice Address - Street 1:604 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-1769
Practice Address - Country:US
Practice Address - Phone:931-723-3051
Practice Address - Fax:931-723-3632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNI00000001631251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health