| NPI | 1225398159 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LIVINUS C. UBA Counseling Supervisor 606-393-4632 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: KY 1179) |
| Additional Taxonomies | 261QM2800X Clinic/Center, Methadone Clinic (Licence: OH 121019) |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: 710053) | |
| Enumeration Date | 2012-05-25 |
| Last Update Date | 2012-05-25 |