Individual
ANASTASIA STACY WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC
Contact information
Practice address
118 WEST UNION STREET, MUNFORDVILLE, KY 42765
(270) 524-9883
(270) 524-0437
Mailing address
1686 MOREHEAD RD, BOWLING GREEN, KY 42101-6304
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0762
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30604011
—
KY
Enumeration date
02/23/2007
Last updated
07/08/2007
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