Organization
CLINICAL AND FORENSIC PSYCHOLOGY PROFESSIONAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENDRA DAVIS (CREDENTIALING COODINATOR)
(865) 246-2104
Entity
Organization
Contact information
Practice address
812 N CHARLOTTE ST, DICKSON, TN 37055-1009
(615) 446-8046
Mailing address
PO BOX 5777, MARYVILLE, TN 37802-5777
(865) 246-2104
(865) 246-2106
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
3431
TN
Other
Enumeration date
07/27/2018
Last updated
07/27/2018
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