Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 164501 | KY |
NPI | 1003303884 |
---|---|
Provider Name | Mr. Gatt Read Ware SR. |
First Address | Bowling Green, KY 42103-6124 |
Second Address | Bowling Green, KY 42103-6124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2018 |
Last Update Date | 17/04/2018 |