Organization
MDC2 LLC
Active
Other names
Restoration House
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARYDORA CONLEY LMFT/LCSW (CLINICAL PARTNER)
(502) 618-1201
Entity
Organization
Contact information
Practice address
9319 TAYLORSVILLE RD, LOUISVILLE, KY 40299-1737
(502) 618-1201
(502) 618-2609
Mailing address
9319 TAYLORSVILLE RD, LOUISVILLE, KY 40299-1737
(502) 618-1201
(502) 618-2609
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1966
KY
106H00000X
Marriage & Family Therapist
0575
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1649473133
INDIVIDUAL NPI
KY
Enumeration date
08/06/2007
Last updated
12/23/2009
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