| Premier Service Of Carolina, Inc | |
|
207 N Boone St Ste 300 Johnson City TN 37604-5675 | |
| (704) 985-1189 | |
| (704) 985-1189 |
| Full Name | Premier Service Of Carolina, Inc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 207 N Boone St Ste 300, Johnson City, Tennessee |
| Authorized Official Name and Position | Clarence Lawing (PROGRAM DIRECTOR) |
| Authorized Official Contact | 7049851189 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Service Of Carolina, Inc 109 Penny St Albemarle NC 28001-2803 Ph: (704) 985-1189 | Premier Service Of Carolina, Inc 207 N Boone St Ste 300 Johnson City TN 37604-5675 Ph: (704) 985-1189 |
| NPI Number | 1811433444 |
|---|---|
| Provider Enumeration Date | 01/06/2017 |
| Last Update Date | 03/14/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811433444 | NPI | - | NPPES |
| Q021696 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | I000000019328 (Tennessee) | Secondary |
| 251S00000X | Community/behavioral Health | I000000021371 (Tennessee) | Primary |
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