Organization
KCCS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY HENDERSON (PROGRAM AMINISTRATOR)
(859) 887-0325
Entity
Organization
Contact information
Practice address
102 S 1ST ST, NICHOLASVILLE, KY 40356-1526
(859) 887-0325
(859) 887-2831
Mailing address
102 S 1ST ST, NICHOLASVILLE, KY 40356-1526
(859) 887-0325
(859) 887-2831
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
101YA0400X
KY
324500000X
Substance Abuse Rehabilitation Facility
324500000X
KY
Other
Enumeration date
06/13/2011
Last updated
06/13/2011
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