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General NPI Number Information
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NPI Number | 1447653019
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Entity Type | Organization
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Legal Business Name | SEVEN COUNTIES
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Dates
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Enumeration Date | 09/26/2014
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Last Update Date | 09/26/2014
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Provider Practice Location Address
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Address Line | 8202 VERMISSA CT APT. 4
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City | LOUISVILLE
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State | KY
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Zip | 40222-3790
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Country | US
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Telephone | 502-419-5466
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Fax |
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Provider Business Mailing Address
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Address Line | 8202 VERMISSA CT APT. 4
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City | LOUISVILLE
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State | KY
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Zip | 40222-3790
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Country | US
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Telephone | 502-419-5466
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL CASE MANAGER
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Name | SHANIQUA L. POTTER
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Credential |
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Telephone | 502-419-5466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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