| NPI | 1710427752 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA AVERY Medical Director 859-303-9436 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2017-02-23 |
| Last Update Date | 2017-03-24 |