Organization
KCC RECOVERY, LLC DBA BLUEGRASS RECOVERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARONICA LAWSON MBA (CEO)
(502) 483-1862
Entity
Organization
Contact information
Practice address
1169 EASTERN PKWY STE 3310, LOUISVILLE, KY 40217-1415
(502) 443-5273
(502) 333-9180
Mailing address
17127 PITON WAY, LOUISVILLE, KY 40245-5409
(502) 483-1862
(502) 333-9180
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100342240
—
KY
Enumeration date
07/03/2018
Last updated
06/30/2020
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