Healthcare Provider Details

I. General information

NPI: 1205765674
Provider Name (Legal Business Name): MORGAN PAIGE SPOREA TCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 BRETT CHASE
PADUCAH KY
42003-5766
US

IV. Provider business mailing address

117 LYNN NELSON RD
BENTON KY
42025-5341
US

V. Phone/Fax

Practice location:
  • Phone: 270-238-3799
  • Fax:
Mailing address:
  • Phone: 270-703-8133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number305789
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: