Organization
COMMONWEALTH COUNSELING CENTERS LLC
Active
Organization
COMMONWEALTH COUNSELING CENTERS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BENJAMIN DORSEY FERGUSON IV M.ED,LCADC, CSS (CLINICAL DIRECTOR/SUPERVISOR)
(606) 506-5077
Entity
Organization
Contact information
Practice address
156 N LAKE DR, PRESTONSBURG, KY 41653-1270
(606) 506-5077
(606) 506-5039
Mailing address
PO BOX 636, PRESTONSBURG, KY 41653
(606) 506-5077
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
1361
KY
324500000X
Substance Abuse Rehabilitation Facility
Primary
810470
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100436100
—
KY
Enumeration date
05/08/2015
Last updated
03/17/2018
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