| NPI | 1073295929 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKIE SANDERS Credentialing 502-630-2036 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2023-08-01 |
| Last Update Date | 2024-07-01 |