Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003240953 |
---|---|
Provider Name | Mr. John W. Riley |
First Address | Hazard, KY 41701-9443 |
Second Address | Hazard, KY 41701-9443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2013 |
Last Update Date | 22/12/2015 |