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General NPI Number Information
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NPI Number | 1487594578
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Entity Type | Organization
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Legal Business Name | LEGACY RECOVERY FOR WOMEN
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Dates
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Enumeration Date | 03/30/2026
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Last Update Date | 03/30/2026
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Provider Practice Location Address
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Address Line | 910 GARDENIA DR
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City | CAMPBELLSVILLE
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State | KY
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Zip | 42718-1933
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Country | US
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Telephone | 270-849-7312
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Fax |
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Provider Business Mailing Address
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Address Line | 910 GARDENIA DR
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City | CAMPBELLSVILLE
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State | KY
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Zip | 42718-1933
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Country | US
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Telephone | 270-849-7312
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MR. DEREK BISHOP
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Credential | MBA
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Telephone | 270-268-2232
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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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