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Organization
FRONTIER HEALTH
Active
Organization
FRONTIER HEALTH
Active
Other names
Holston Children & Youth Services
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERESA M KIDD PHD (PRESIDENT AND CEO)
(423) 467-3600
Entity
Organization
Contact information
Practice address
2001 STONEBROOK PL, KINGSPORT, TN 37660-4000
(423) 224-1000
(423) 224-1023
Mailing address
PO BOX 9054, GRAY, TN 37615-9054
(423) 467-3600
(423) 467-3644
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
L 214-076-1417
TN
251S00000X
Community/Behavioral Health Agency
L 214-076-1417
TN
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
L 214-076-1417
TN
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
316
TN
Other
Enumeration date
12/20/2006
Last updated
12/12/2018
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