Healthcare Provider Details

I. General information

NPI: 1023668621
Provider Name (Legal Business Name): STEPHEN SHAWN WRIGHT CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10057 ELKHORN CRK
ASHCAMP KY
41512-8702
US

IV. Provider business mailing address

10057 ELKHORN CRK
ASHCAMP KY
41512-8702
US

V. Phone/Fax

Practice location:
  • Phone: 606-757-7077
  • Fax: 606-754-7079
Mailing address:
  • Phone: 606-754-7077
  • Fax: 606-754-7079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number165972
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: