Healthcare Provider Details

I. General information

NPI: 1396265989
Provider Name (Legal Business Name): KENTUCKY OHANNA INITIATIVE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1795 ALYSHEBA WAY STE 1001
LEXINGTON KY
40509-2282
US

IV. Provider business mailing address

1795 ALYSHEBA WAY STE 1001
LEXINGTON KY
40509-2282
US

V. Phone/Fax

Practice location:
  • Phone: 859-687-0416
  • Fax: 859-353-4200
Mailing address:
  • Phone: 859-687-0416
  • Fax: 859-353-4200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateKY
# 7
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateKY

VIII. Authorized Official

Name: STEVANIE SMITH
Title or Position: DIRECTOR
Credential: LPCC, LPCADC, MAC
Phone: 859-687-0416