| NPI | 1518712538 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FONDA DICKERSON Owner 502-384-1378 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0800X Clinic/Center Recovery Care |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YM0800X Counselor Mental Health | |
| 101YP2500X Counselor Professional | |
| 171M00000X Case Manager/Care Coordinator | |
| 172V00000X Community Health Worker | |
| 175T00000X Peer Specialist | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2024-04-22 |
| Last Update Date | 2025-05-12 |