Organization
SELF RENEW LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID GEARHEART CADC (PRESIDENT/CEO)
(606) 369-3180
Entity
Organization
Contact information
Practice address
308 CUMBERLAND AVE, WILLIAMSBURG, KY 40769-1292
(606) 369-3180
Mailing address
603 RIVERSIDE DR, PRESTONSBURG, KY 41653-7746
(606) 369-3180
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
05/04/2023
Last updated
05/04/2023
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