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General NPI Number Information
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NPI Number | 1780286757
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Entity Type | Organization
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Legal Business Name | VERGE KC LLC
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Dates
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Enumeration Date | 11/13/2020
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Last Update Date | 11/13/2020
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Provider Practice Location Address
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Address Line | 4121 W 83RD ST STE 227
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66208-5323
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Country | US
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Telephone | 913-270-2401
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Fax |
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Provider Business Mailing Address
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Address Line | 119 W GREGORY BLVD UNIT 8645
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City | KANSAS CITY
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State | MO
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Zip | 64114-1338
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | JOY DURHAM
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Credential | LSCSW, LCSW, LMAC
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Telephone | 913-270-2401
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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 | 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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