Individual
MATTHEW LEE WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
125 S MAIN CROSS ST, LOUISA, KY 41230-1065
(606) 638-0938
(859) 813-5394
Mailing address
125 S MAIN CROSS ST, LOUISA, KY 41230-1065
(606) 638-0938
(859) 813-5394
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
273260
KY
Other
Enumeration date
05/10/2023
Last updated
05/10/2023
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