Provider Demographics
NPI:1891503876
Name:WEST TN FAMILY & CRISIS SERVICES CENTER LLC
Entity type:Organization
Organization Name:WEST TN FAMILY & CRISIS SERVICES CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO-CLINICAL FORENSIC SOCIAL WORKER
Authorized Official - Prefix:PROF
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:DEWAYNE
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW,MSSW, MHRT
Authorized Official - Phone:901-206-6250
Mailing Address - Street 1:116 AGNES RD STE 200
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-6306
Mailing Address - Country:US
Mailing Address - Phone:901-206-6250
Mailing Address - Fax:
Practice Address - Street 1:825 BERCLAIR RD APT 8
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38122-5404
Practice Address - Country:US
Practice Address - Phone:901-206-6250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No364SP0812XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, CommunityGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNFP1810OtherSTATE LICENSING BOARD OF SOCIAL WORK