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General NPI Number Information
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NPI Number | 1205267671
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Entity Type | Organization
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Legal Business Name | ASSUREDLINK CASE MANAGEMENT AGENCY
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Dates
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Enumeration Date | 12/10/2013
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Last Update Date | 03/03/2017
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Provider Practice Location Address
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Address Line | 1990 LOUISVILLE RD 101
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City | BOWLING GREEN
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State | KY
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Zip | 42101-1202
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Country | US
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Telephone | 270-599-0212
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Fax |
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Provider Business Mailing Address
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Address Line | 1990 LOUISVILLE RD 101
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City | BOWLING GREEN
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State | KY
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Zip | 42101-1202
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Country | US
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Telephone | 270-599-0212
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Fax |
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Authorized Official
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Title or Position | OWNER/ EXECUTIVE DIRECTOR
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Name | MS. DEMETRIUS DEPP KING
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Credential | E.D.
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Telephone | 270-303-4669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 171431
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 7100347620
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | K12245600
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License Number State | KY
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