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General NPI Number Information
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NPI Number | 1659521920
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH SUBSTANCE ABUSE SPECIALIST
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Dates
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Enumeration Date | 09/24/2008
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Last Update Date | 09/24/2008
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Provider Practice Location Address
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Address Line | 7000 HOUSTON RD BLDG. 400, SUITE, 43
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City | FLORENCE
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State | KY
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Zip | 41042-4873
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Country | US
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Telephone | 859-371-4455
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Fax | 859-371-2454
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Provider Business Mailing Address
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Address Line | 7000 HOUSTON RD BLDG. 400, SUITE, 43
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City | FLORENCE
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State | KY
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Zip | 41042-4873
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Country | US
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Telephone | 859-371-4455
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Fax | 859-371-2454
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Authorized Official
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Title or Position | PROGRAM DIRECTOR/OWNER
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Name | MR. MICHAEL T. TONER
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Credential | L.C.S.W.
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Telephone | 859-371-4455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | P-45
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License Number State | KY
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