Organization
ILLUMINARE LLC
Active
Other names
Illuminare
Organization subpart
No
Provider details
NPI number
Authorized official
GRETCHEN DAVIS (CEO)
(270) 377-7137
Entity
Organization
Contact information
Practice address
601 GREENE DR, GREENVILLE, KY 42345-1451
(270) 377-7137
(270) 641-0857
Mailing address
PO BOX 42, POWDERLY, KY 42367-0042
(270) 377-7137
(270) 641-0857
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
09/10/2018
Last updated
09/09/2022
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