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General NPI Number Information
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NPI Number | 1215367578
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Entity Type | Organization
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Legal Business Name | SOCIAL DEVELOPMENT, LLC
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Dates
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Enumeration Date | 11/22/2013
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Last Update Date | 11/22/2013
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Provider Practice Location Address
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Address Line | 857 MALLARD CREEK RD
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City | LOUISVILLE
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State | KY
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Zip | 40207-5481
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Country | US
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Telephone | 502-314-0671
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Fax | 502-873-5600
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Provider Business Mailing Address
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Address Line | 857 MALLARD CREEK RD
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City | LOUISVILLE
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State | KY
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Zip | 40207-5481
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Country | US
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Telephone | 502-314-0671
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Fax | 502-873-5600
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Authorized Official
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Title or Position | CEO
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Name | BRADLEY ABNER
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Credential | M.S., BCBA
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Telephone | 502-314-0671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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