Organization
LIFECHANGERS OUTREACH
Active
Other names
LifeChangers IOP
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW JOHNSON M.A., M.DIV (EXECUTIVE DIRECTOR)
(865) 805-0567
Entity
Organization
Contact information
Practice address
2450 WINFIELD DUNN PKWY, KODAK, TN 37764-2100
(865) 805-0567
Mailing address
404 HOLLY CT, SEVIERVILLE, TN 37862-5314
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
1000000021300
TN
Other
Enumeration date
12/19/2017
Last updated
09/25/2018
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