Organization
PURPOSE DRIVEN SUPPORT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMANTHA STUMBO (EXECUTIVE DIRECTOR)
(606) 359-0700
Entity
Organization
Contact information
Practice address
9575 KY HWY 122 STE 6, EAST MCDOWELL, KY 41647
(606) 359-0700
Mailing address
9575 KY HWY 122 STE 6, EAST MCDOWELL, KY 41647
(606) 359-0700
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
106H00000X
Marriage & Family Therapist
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
207RA0401X
Addiction Medicine (Internal Medicine) Physician
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
05/08/2025
Last updated
05/08/2025
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