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General NPI Number Information
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NPI Number | 1548839285
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Entity Type | Organization
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Legal Business Name | CHRONIC ILLNESS COUNSELING CENTER LLC
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Dates
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Enumeration Date | 06/17/2021
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 13804 LAKE POINT CIR STE 101
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City | LOUISVILLE
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State | KY
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Zip | 40223-4239
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Country | US
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Telephone | 502-805-5858
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Fax | 502-805-5859
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Provider Business Mailing Address
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Address Line | 13804 LAKE POINT CIR STE 101
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City | LOUISVILLE
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State | KY
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Zip | 40223-4239
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Country | US
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Telephone | 502-558-0696
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Fax |
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Authorized Official
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Title or Position | OWNER/SOLE MEMBER
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Name | JAYAN THOMAS
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Credential |
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Telephone | 502-805-5858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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