Provider Demographics
NPI:1447664271
Name:WKDA SERVICES LLC
Entity type:Organization
Organization Name:WKDA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROGRAM ADMINSTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:270-247-4212
Mailing Address - Street 1:1720 E REELFOOT AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-6047
Mailing Address - Country:US
Mailing Address - Phone:731-884-9010
Mailing Address - Fax:270-247-2017
Practice Address - Street 1:1720 E REELFOOT AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-6047
Practice Address - Country:US
Practice Address - Phone:731-884-9010
Practice Address - Fax:270-247-2017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNI000000013974251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health