Healthcare Provider Details

I. General information

NPI: 1972417459
Provider Name (Legal Business Name): TITO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 N HAMILTON ST STE 101
GEORGETOWN KY
40324-1791
US

IV. Provider business mailing address

130 N HAMILTON ST STE 101
GEORGETOWN KY
40324-1791
US

V. Phone/Fax

Practice location:
  • Phone: 502-557-2752
  • Fax:
Mailing address:
  • Phone: 502-557-2752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: ERICA DAVENPORT
Title or Position: FOUNDER
Credential: PEER SUPPORT SPECIAL
Phone: 502-557-2752