Provider Demographics
NPI:1982867040
Name:TENNESSEE COMMUNITY COUNSELING SERVICES, INC.
Entity Type:Organization
Organization Name:TENNESSEE COMMUNITY COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:NCACII, SAP, TN LIC
Authorized Official - Phone:423-296-6451
Mailing Address - Street 1:5600 BRAINERD RD
Mailing Address - Street 2:SUITE B-42
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-5310
Mailing Address - Country:US
Mailing Address - Phone:423-296-6451
Mailing Address - Fax:423-296-6515
Practice Address - Street 1:5600 BRAINERD RD
Practice Address - Street 2:SUITE B-42
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-5310
Practice Address - Country:US
Practice Address - Phone:423-296-6451
Practice Address - Fax:423-296-6515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1000000002842101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1000000002842OtherSTATE OF TENNESSEE DEPARTMENT OF MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES