Provider Demographics
NPI:1750125498
Name:WEBSTERS RECOVERY
Entity type:Organization
Organization Name:WEBSTERS RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRODERICK
Authorized Official - Middle Name:DWAYNE
Authorized Official - Last Name:WEBSTER
Authorized Official - Suffix:SR
Authorized Official - Credentials:NCC
Authorized Official - Phone:901-620-7289
Mailing Address - Street 1:844 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38107-4611
Mailing Address - Country:US
Mailing Address - Phone:901-620-7289
Mailing Address - Fax:
Practice Address - Street 1:844 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38107-4611
Practice Address - Country:US
Practice Address - Phone:901-620-7289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty