| NPI | 1821402843 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELYN BAINBRIDGE Lpcc 502-445-8376 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: KY LPCPCC00223151) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2015-11-18 |