Organization
KENTUCKY PHOENIX PROJECT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CASEY COLLIER (COO)
(606) 471-4546
Entity
Organization
Contact information
Practice address
5230 KY ROUTE 321 STE 6, PRESTONSBURG, KY 41653-9169
(606) 459-5001
(606) 548-5477
Mailing address
PO BOX 126, PRESTONSBURG, KY 41653-0126
(606) 459-5001
(606) 548-5477
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
09/13/2023
Last updated
11/28/2023
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