| Victory Center | |
|
2243 Eddie Williams Rd Johnson City TN 37601-2872 | |
| (423) 928-5627 | |
| (423) 928-4222 |
| Full Name | Victory Center |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 2243 Eddie Williams Rd, Johnson City, Tennessee |
| Authorized Official Name and Position | Teresa M Kidd (PRESIDENT AND CEO) |
| Authorized Official Contact | 4234673600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Victory Center Po Box 9054 Gray TN 37615-9054 Ph: (423) 467-3600 | Victory Center 2243 Eddie Williams Rd Johnson City TN 37601-2872 Ph: (423) 928-5627 |
| NPI Number | 1730245010 |
|---|---|
| Provider Enumeration Date | 12/29/2006 |
| Last Update Date | 12/12/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730245010 | NPI | - | NPPES |
| 49-4920-0 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | L 229-076-1429 (Tennessee) | Primary |
| 261QR0400X | Clinic/center - Rehabilitation | L 229-076-1429 (Tennessee) | Secondary |
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