Individual
REGINALD EZELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CADC
Contact information
Practice address
1017 W MARKET ST, LOUISVILLE, KY 40202
(502) 585-4848
Mailing address
1020 W MARKET ST, LOUISVILLE, KY 40202-2630
(502) 585-4848
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
119916
KY
Other
Enumeration date
02/09/2017
Last updated
02/09/2017
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