Organization
PURPOSE DRIVEN SUPPORT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMANTHA STUMBO LMFT, TCADC (ED/ OWNER)
(606) 359-0700
Entity
Organization
Contact information
Practice address
9575 KY HWY 122, SUITE 6, EAST MC DOWELL, KY 41647-4164
(606) 949-1623
Mailing address
PO BOX 41, MC DOWELL, KY 41647-0041
(063) 590-7006
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
106H00000X
Marriage & Family Therapist
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100674370
—
KY
Enumeration date
06/16/2020
Last updated
02/16/2024
Update your record
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