# CLEANSE CLINIC, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659726628
- **Authorized official:** MARGARET ANN GROLL (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (812) 987-4330

## Contact information

- **Practice address:** 645 S ROY WILKINS AVE STE 100, LOUISVILLE, KY 40203-2072
- **Practice address phone:** (502) 583-4092
- **Practice address fax:** (502) 371-6110
- **Mailing address:** 720 W BROADWAY STE 202, LOUISVILLE, KY 40202-3245
- **Mailing address phone:** (502) 583-4092
- **Mailing address fax:** (502) 371-6110

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0802X | Addiction Psychiatry Physician | 800212 | KY | Yes |

## Other

- **Enumeration date:** 04/27/2016
- **Last updated:** 10/10/2026