| NPI | 1922562453 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL J MCDONALD Program Administrator 502-995-3350 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2020-01-08 |