| Organization Name: | CRAZY WISDOM JOURNEY, LLC |
| NPI Number: | 1689951725 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DEBRA VELETA FOSTER (CO-OWNER) |
| Mailing Address: | 1447 Highway 96 Burns |
| State: | TN US |
| Postal Code: | 370295029 |
| Phone Number: | 6152926399 |
| Fax Number: | |
| NPI Enumeration Date: | 11/03/2011 |
| NPI Last Update Date: | 11/03/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |