Provider Demographics
NPI:1699480384
Name:DOGWOOD MENTAL HEALTH, LLC
Entity type:Organization
Organization Name:DOGWOOD MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SALERNO
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:865-705-6279
Mailing Address - Street 1:713 WINFIELD DUNN PKWY # 1027
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37876-5532
Mailing Address - Country:US
Mailing Address - Phone:865-705-6279
Mailing Address - Fax:
Practice Address - Street 1:508 DOC NORTON RD
Practice Address - Street 2:
Practice Address - City:WALLAND
Practice Address - State:TN
Practice Address - Zip Code:37886-2002
Practice Address - Country:US
Practice Address - Phone:865-705-6279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN092401201OtherDRIVERS LICENSE