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General NPI Number Information
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NPI Number | 1720468937
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Entity Type | Organization
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Legal Business Name | VANARK BEHAVIORAL MANAGEMENT, INC.
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Dates
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Enumeration Date | 06/02/2015
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Last Update Date | 06/04/2015
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Provider Practice Location Address
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Address Line | 207 W COURT ST
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City | PRESTONSBURG
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State | KY
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Zip | 41653-7732
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Country | US
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Telephone | 606-886-9989
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Fax | 606-889-8603
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Provider Business Mailing Address
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Address Line | PO BOX 92
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City | PRESTONSBURG
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State | KY
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Zip | 41653-0092
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Country | US
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Telephone | 606-886-9989
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Fax | 606-889-8603
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Authorized Official
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Title or Position | OWNER
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Name | RHONDA K CLARK
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Credential | BSW,ICADC,CSS
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Telephone | 606-886-9989
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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 | 810154
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License Number State | KY
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