Individual
KEVIN MICHAEL SOUTHERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BA
Contact information
Practice address
1609 W 3RD AVE, WILLIAMSON, WV 25661-3006
(304) 932-0779
Mailing address
PO BOX 219, HOLDEN, WV 25625-0219
(304) 946-7269
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
11/03/2021
Last updated
11/03/2021
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