| NPI | 1477259117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIRAN H MCCLENDON Owner 502-819-3138 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2023-02-03 |
| Last Update Date | 2024-01-26 |