Individual
MR. GEORGE GLEN MASSENGILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADAC
Contact information
Practice address
188 INDIAN MOUND CIR, JACKSBORO, TN 37757-2100
(423) 566-2437
(423) 566-2948
Mailing address
188 INDIAN MOUND CIR, JACKSBORO, TN 37757-2100
(423) 566-2437
(423) 566-2948
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
580
TN
Other
Enumeration date
11/30/2009
Last updated
11/30/2009
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