Healthcare Provider Details

I. General information

NPI: 1528556552
Provider Name (Legal Business Name): EMILY CAGLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1974 WALTON NICHOLSON PIKE
INDEPENDENCE KY
41051-7906
US

IV. Provider business mailing address

55 BEATTIE PL STE 810
GREENVILLE SC
29601-2191
US

V. Phone/Fax

Practice location:
  • Phone: 859-359-5404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: