| NPI | 1669093647 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE R HICKS Owner 502-612-6981 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 175T00000X Peer Specialist | |
| 207V00000X Obstetrics & Gynecology | |
| 251B00000X Case Management | |
| Enumeration Date | 2020-05-01 |
| Last Update Date | 2020-07-09 |