Organization
KINGSPORT COUNSELING ASSOCIATES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. L GORDON BREWER JR. LMFT (PRESIDENT)
(423) 408-2601
Entity
Organization
Contact information
Practice address
1417 WARPATH DR, SUITE B, KINGSPORT, TN 37664-3333
(423) 408-2601
(888) 395-1262
Mailing address
5337 HERITAGE LN, KINGSPORT, TN 37664-9504
(423) 408-2601
(888) 395-1262
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
617
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1507171
—
TN
Enumeration date
03/03/2014
Last updated
03/03/2014
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