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General NPI Number Information
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NPI Number | 1669093647
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Entity Type | Organization
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Legal Business Name | LOUISVILLE INTEGRATED CARE
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Dates
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Enumeration Date | 05/01/2020
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Last Update Date | 07/09/2020
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Provider Practice Location Address
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Address Line | 1151 S 4TH ST STE 208
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City | LOUISVILLE
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State | KY
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Zip | 40203-3101
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Country | US
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Telephone | 502-612-6981
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Fax |
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Provider Business Mailing Address
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Address Line | 1151 S 4TH ST STE 208
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City | LOUISVILLE
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State | KY
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Zip | 40203-3101
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Country | US
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Telephone | 502-612-6981
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE R HICKS
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Credential | CADC
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Telephone | 502-612-6981
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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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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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