Healthcare Provider Details

I. General information

NPI: 1518994474
Provider Name (Legal Business Name): LIBBY BURRIS CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 ADANTA CIR
ALBANY KY
42602-9549
US

IV. Provider business mailing address

130 SOUTHERN SCHOOL RD
SOMERSET KY
42501-3223
US

V. Phone/Fax

Practice location:
  • Phone: 606-387-7635
  • Fax:
Mailing address:
  • Phone: 606-679-4782
  • Fax: 606-678-5296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number581
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number506
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: