| Self Renew Llc | |
|
308 Cumberland Ave Williamsburg KY 40769-1292 | |
| (606) 369-3180 | |
| Not Available |
| Full Name | Self Renew Llc |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 308 Cumberland Ave, Williamsburg, Kentucky |
| Authorized Official Name and Position | David Gearheart (PRESIDENT/CEO) |
| Authorized Official Contact | 6063693180 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Self Renew Llc 603 Riverside Dr Prestonsburg KY 41653-7746 Ph: (606) 369-3180 | Self Renew Llc 308 Cumberland Ave Williamsburg KY 40769-1292 Ph: (606) 369-3180 |
| NPI Number | 1013606144 |
|---|---|
| Provider Enumeration Date | 05/04/2023 |
| Last Update Date | 05/04/2023 |
| Certification Date | 05/04/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013606144 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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