| NPI | 1336213784 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM MATT ELLISON Proprietor 606-526-9500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY KY0480) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY KY1625) |
| Enumeration Date | 2006-11-19 |
| Last Update Date | 2020-08-22 |