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General NPI Number Information
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NPI Number | 1104607613
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Entity Type | Organization
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Legal Business Name | STABLE RECOVERY, INC.
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Dates
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Enumeration Date | 10/10/2023
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Last Update Date | 10/30/2023
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Provider Practice Location Address
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Address Line | 321 HUMMINGBIRD LN
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City | LEXINGTON
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State | KY
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Zip | 40503-1111
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Country | US
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Telephone | 859-351-9703
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Fax |
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Provider Business Mailing Address
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Address Line | 321 HUMMINGBIRD LN
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City | LEXINGTON
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State | KY
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Zip | 40503-1111
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. CHRISTIAN COUNTZLER
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Credential |
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Telephone | 859-221-1007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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