| NPI | 1275842213 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY LEE HICKS Member 502-245-7258 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 104100000X Social Worker |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 101YM0800X Counselor, Mental Health | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2010-09-24 |
| Last Update Date | 2012-12-12 |