Healthcare Provider Details

I. General information

NPI: 1053692012
Provider Name (Legal Business Name): AWARENESS AND DISCOVERY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 09/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 DORTHA AVE
FLORENCE KY
41042-2014
US

IV. Provider business mailing address

2 DORTHA AVE
FLORENCE KY
41042-2014
US

V. Phone/Fax

Practice location:
  • Phone: 859-525-1487
  • Fax: 859-525-7811
Mailing address:
  • Phone: 859-525-1487
  • Fax: 859-525-7811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RICK N. HAMM
Title or Position: DIRECTOR OF CLINICAL SERVICES
Credential: LCSW
Phone: 859-525-1487