Organization
LIFE & HEALTH SERVICES
Active
Organization
LIFE & HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TINA T POORE OM (SECRETARY)
(606) 242-2519
Entity
Organization
Contact information
Practice address
1814 CUMBERLAND AVENUE, MIDDLESBORO, KY 40965
(606) 242-2519
(606) 242-2520
Mailing address
1814 CUMBERLAND AVENUE, MIDDLESBORO, KY 40965
(606) 242-2519
(606) 242-2520
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
800179
KY
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
40049
KY
Other
Enumeration date
09/19/2014
Last updated
08/31/2016
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