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Organization
REBELLIOUS RECOVERY LLC
Active
Organization
REBELLIOUS RECOVERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACY KIRKHAM LCADC (OWNER)
(270) 392-2375
Entity
Organization
Contact information
Practice address
3011 JEFFERSON ST APT D, PADUCAH, KY 42001-4373
(270) 392-2375
Mailing address
3011 JEFFERSON ST APT D, PADUCAH, KY 42001-4373
(270) 392-2375
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
09/24/2026
Last updated
09/24/2026
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