| NPI | 1568864734 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA T POORE Secretary 606-242-2519 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY 800179) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: KY 40049) |
| Enumeration Date | 2014-09-19 |
| Last Update Date | 2016-08-31 |