| NPI | 1447932629 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONICA LAWRENCE Credentialing Specialist 502-656-2429 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2023-08-07 |
| Last Update Date | 2023-08-07 |