Provider Demographics
NPI:1366140824
Name:MIDDLE TN FAMILY SERVICES CENTER, LLC
Entity type:Organization
Organization Name:MIDDLE TN FAMILY SERVICES CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL FORENSIC SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:DEWAYNE
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, BSSW, MHRT-CRP
Authorized Official - Phone:901-206-6250
Mailing Address - Street 1:138 W FOWLKES ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-3534
Mailing Address - Country:US
Mailing Address - Phone:901-206-6250
Mailing Address - Fax:
Practice Address - Street 1:138 W FOWLKES ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-3534
Practice Address - Country:US
Practice Address - Phone:865-390-1403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNFP16810OtherLCSW, MSSW LICENSE TN STATE