Provider Demographics
NPI:1336604461
Name:NORTHGLEN HEALING, PLLC
Entity Type:Organization
Organization Name:NORTHGLEN HEALING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:865-201-8112
Mailing Address - Street 1:7527 JENKINS RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-4416
Mailing Address - Country:US
Mailing Address - Phone:865-235-5741
Mailing Address - Fax:
Practice Address - Street 1:10820 KINGSTON PIKE STE 4
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-3065
Practice Address - Country:US
Practice Address - Phone:865-201-8112
Practice Address - Fax:865-297-4221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-03
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty