Organization
CHRONIC ILLNESS COUNSELING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAYAN THOMAS (OWNER/SOLE MEMBER)
(502) 805-5858
Entity
Organization
Contact information
Practice address
13804 LAKE POINT CIR STE 101, LOUISVILLE, KY 40223-4239
(502) 805-5858
(502) 805-5859
Mailing address
13804 LAKE POINT CIR STE 101, LOUISVILLE, KY 40223-4239
(502) 558-0696
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1609989151
—
KY
Enumeration date
06/17/2021
Last updated
12/09/2024
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