Provider Demographics
NPI:1952852261
Name:WATAUGA RECOVERY CENTER WYTHEVILLE
Entity Type:Organization
Organization Name:WATAUGA RECOVERY CENTER WYTHEVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:C
Authorized Official - Last Name:LINKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-631-0432
Mailing Address - Street 1:255 HOLSTON RD
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-4448
Mailing Address - Country:US
Mailing Address - Phone:276-227-0206
Mailing Address - Fax:276-227-0856
Practice Address - Street 1:255 HOLSTON RD
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:04382-4448
Practice Address - Country:US
Practice Address - Phone:276-227-0206
Practice Address - Fax:276-227-0856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041174207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty