Organization
HOME AWAY FROM HOME THERAPEUTIC CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAQUILA COOPER DSW, LCSW (OWENER/OPERATOR)
(502) 618-9205
Entity
Organization
Contact information
Practice address
849 S 37TH ST, LOUISVILLE, KY 40211-2811
(502) 618-9204
Mailing address
1828 BOLLING AVE, LOUISVILLE, KY 40210-1908
(502) 618-9205
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
11/22/2023
Last updated
11/22/2023
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