Individual
DARRYL D WALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC
Contact information
Practice address
2133 W MARKET ST, LOUISVILLE, KY 40212-1532
(502) 384-5807
Mailing address
2133 W MARKET ST, LOUISVILLE, KY 40212-1532
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
120003
KY
Other
Enumeration date
09/24/2019
Last updated
09/24/2019
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