Organization
INDEPENDANCE ADULT TREATMENT SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LATONYA LONG (CO-OWNER)
(404) 510-2058
Entity
Organization
Contact information
Practice address
709 DODDS AVE, CHATTANOOGA, TN 37404-3913
(423) 521-3083
(423) 289-3567
Mailing address
709 DODDS AVE, CHATTANOOGA, TN 37404-3913
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
I000000012355
TN
Other
Enumeration date
02/11/2013
Last updated
08/06/2013
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