Organization
ENSITE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL W DURBIN (OWNER)
(270) 443-1201
Entity
Organization
Contact information
Practice address
611 BROADWAY ST, PADUCAH, KY 42001-6869
(270) 443-1201
Mailing address
611 BROADWAY ST, PADUCAH, KY 42001-6869
(270) 443-1201
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
IL
Other
Enumeration date
04/07/2015
Last updated
04/07/2015
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