| NPI | 1689245813 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE SANDERS Credentialing Admn 502-200-3550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 251S00000X | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2021-07-08 |
| Last Update Date | 2024-07-04 |