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General NPI Number Information
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NPI Number | 1275947905
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Entity Type | Organization
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Legal Business Name | WKDA SERVICES LLC
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Dates
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Enumeration Date | 06/20/2014
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 120 N 9TH ST
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City | MAYFIELD
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State | KY
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Zip | 42066-1800
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Country | US
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Telephone | 270-247-4212
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Fax | 270-247-2017
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Provider Business Mailing Address
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Address Line | PO BOX 374
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City | MAYFIELD
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State | KY
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Zip | 42066-0029
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Country | US
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Telephone | 270-247-4212
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Fax | 270-247-2017
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Authorized Official
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Title or Position | OWNER/PROGRAM ADMINSTRATOR
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Name | MR. MARTY COBB
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Credential | BS
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Telephone | 270-247-4212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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