| Shattered 2 Restored | |
|
7659 Mall Rd # 1016 Florence KY 41042-1403 | |
| (859) 379-8152 | |
| Not Available |
| Full Name | Shattered 2 Restored |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 7659 Mall Rd # 1016, Florence, Kentucky |
| Authorized Official Name and Position | Chenel M. Stewart (OWNER/CLINICIAN) |
| Authorized Official Contact | 2708752548 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shattered 2 Restored 7659 Mall Rd # 1016 Florence KY 41042-1403 Ph: (859) 379-8152 | Shattered 2 Restored 7659 Mall Rd # 1016 Florence KY 41042-1403 Ph: (859) 379-8152 |
| NPI Number | 1285206656 |
|---|---|
| Provider Enumeration Date | 07/14/2021 |
| Last Update Date | 07/14/2021 |
| Certification Date | 07/14/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285206656 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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