Healthcare Provider Details

I. General information

NPI: 1306201280
Provider Name (Legal Business Name): A A AND ASSOCIATES APPROVED ALCOHOL/DRUG PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2015
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4006 DUTCHMANS LANE
LOUISVILLE KY
40207
US

IV. Provider business mailing address

4006 DUTCHMANS LANE SUITE 200
LOUISVILLE KY
40207
US

V. Phone/Fax

Practice location:
  • Phone: 502-896-6900
  • Fax: 502-896-8607
Mailing address:
  • Phone: 502-896-6900
  • Fax: 502-896-8607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. DON L. NANNY
Title or Position: ADMINISTRATOR
Credential:
Phone: 502-896-6900