| NPI | 1174284913 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN MITCHELL Credentialing Agent 502-654-3927 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2022-01-04 |
| Last Update Date | 2024-04-04 |