| Independence House | |
|
2532 4th Ave E Big Stone Gap VA 24219-3600 | |
| (276) 523-4357 | |
| (276) 523-2527 |
| Full Name | Independence House |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2532 4th Ave E, Big Stone Gap, Virginia |
| Authorized Official Name and Position | Teresa M Kidd (PRESIDENT AND CEO) |
| Authorized Official Contact | 4234673600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Independence House Po Box 9054 Gray TN 37615-9054 Ph: (423) 467-3600 | Independence House 2532 4th Ave E Big Stone Gap VA 24219-3600 Ph: (276) 523-4357 |
| NPI Number | 1194875039 |
|---|---|
| Provider Enumeration Date | 01/11/2007 |
| Last Update Date | 10/04/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194875039 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 315-02-011 (Virginia) | Primary |
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Blue Ridge Medical Management Corpoartion Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1980 Holton Ave E Ste 103, Big Stone Gap, VA 24219 Phone: 423-302-3480 Fax: 423-722-3009 | |
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