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General NPI Number Information
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NPI Number | 1619578473
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Entity Type | Organization
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Legal Business Name | EASTERN KENTUCKY SPECIALTIES, LLC
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Dates
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Enumeration Date | 11/06/2020
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Last Update Date | 12/14/2020
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Provider Practice Location Address
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Address Line | 1544 WINCHESTER AVE STE 804
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City | ASHLAND
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State | KY
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Zip | 41101-7931
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Country | US
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Telephone | 606-981-0111
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Fax | 606-393-3422
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Provider Business Mailing Address
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Address Line | PO BOX 3
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City | LOUISA
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State | KY
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Zip | 41230-0003
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Country | US
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Telephone |
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Fax | 606-393-3422
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Authorized Official
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Title or Position | CEO
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Name | MR. ALEX CAIN CARTMEL
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Credential | CLC
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Telephone | 606-471-9423
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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