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Organization
LAKE SUBSTANCE ABUSE SOLUTIONS LLC
Active
Organization
LAKE SUBSTANCE ABUSE SOLUTIONS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID CORDDRY (OWNER)
(407) 622-8086
Entity
Organization
Contact information
Practice address
1143 FAIRWAY ST STE 103, BOWLING GREEN, KY 42103-2452
(812) 901-6881
(812) 285-8392
Mailing address
1143 FAIRWAY ST STE 103, BOWLING GREEN, KY 42103-2452
(812) 901-6881
(812) 285-8392
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/03/2026
Last updated
06/03/2026
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