| NPI | 1497572218 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA BURDEN Owner 502-544-9332 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Enumeration Date | 2024-09-23 |
| Last Update Date | 2025-01-24 |