Organization
SMOKETOWN FAMILY WELLNESS CENTER CORP
Active
Other names
Smoketown Family Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLOTTE GAY STITES MD (PHYSICIAN OWNER)
(502) 242-7458
Entity
Organization
Contact information
Practice address
760 S HANCOCK ST APT B100, LOUISVILLE, KY 40203-2449
(502) 242-7458
Mailing address
760 S HANCOCK ST APT B100, LOUISVILLE, KY 40203-2449
(502) 242-7458
(502) 219-3673
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
208000000X
Pediatrics Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
Other
Enumeration date
07/03/2017
Last updated
10/10/2023
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