Provider Demographics
NPI:1215158324
Name:CLINCH VALLEY TREATMENT CENTER
Entity type:Organization
Organization Name:CLINCH VALLEY TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUBSTANCE ABUSE COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PHIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:276-963-3554
Mailing Address - Street 1:111 TOWN HOLLOW RD
Mailing Address - Street 2:CEDAR BLUFF
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:VA
Mailing Address - Zip Code:24609
Mailing Address - Country:US
Mailing Address - Phone:276-963-3554
Mailing Address - Fax:276-963-4653
Practice Address - Street 1:111 TOWN HOLLOW RD
Practice Address - Street 2:CEDAR BLUFF
Practice Address - City:CEDAR BLUFF
Practice Address - State:VA
Practice Address - Zip Code:24609
Practice Address - Country:US
Practice Address - Phone:276-963-3554
Practice Address - Fax:276-963-4653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VALVN-164 X00000X302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization