Organization
CUSTOMIZED VETERANS GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTWANE BOHANON (CHIEF EXECUTIVE OFFICER)
(808) 453-0018
Entity
Organization
Contact information
Practice address
578 HARRELL ST, MEMPHIS, TN 38112-2932
(901) 907-0640
(901) 255-0758
Mailing address
578 HARRELL ST, MEMPHIS, TN 38112-2932
(901) 907-0640
(901) 255-0758
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
01/14/2025
Last updated
01/14/2025
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