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1 Professional Park Dr Suite 21 Room C-17 Johnson City TN 37604-6587 | |
| (423) 232-6900 | |
| (423) 232-6903 |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1 Professional Park Dr, Johnson City, Tennessee |
| Authorized Official Name and Position | Graciela Pereira (AVP) |
| Authorized Official Contact | 4234317060 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1 Professional Park Dr Suite 21 Room C-17 Johnson City TN 37604-6587 Ph: (423) 232-6900 | 1 Professional Park Dr Suite 21 Room C-17 Johnson City TN 37604-6587 Ph: (423) 232-6900 |
| NPI Number | 1649578386 |
|---|---|
| Provider Enumeration Date | 03/04/2011 |
| Last Update Date | 03/04/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649578386 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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