Individual
MISTY WEASE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2396 FRIENDSHIP CHURCH RD, MAGNOLIA, KY 42757-7613
(270) 218-2652
Mailing address
2396 FRIENDSHIP CHURCH RD, MAGNOLIA, KY 42757-7613
(270) 218-2652
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
06/05/2024
Last updated
06/05/2024
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