Provider Demographics
NPI:1992266456
Name:BOTTOMS, ERIC
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:BOTTOMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1088
Mailing Address - Street 2:
Mailing Address - City:NOLENSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37135-1088
Mailing Address - Country:US
Mailing Address - Phone:615-601-0454
Mailing Address - Fax:
Practice Address - Street 1:5205 MARYLAND WAY STE 310
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-1006
Practice Address - Country:US
Practice Address - Phone:615-601-0454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4533101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4533OtherLICENSED PROFESSIONAL COUNSELOR