| NPI | 1386284214 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL JOE MCDONALD Clinical Supervisor 502-896-6900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2020-01-08 |
| Last Update Date | 2020-01-08 |