Organization · NPI-2

124 Recovery LLC

Counselor, Addiction (Substance Use Disorder) · Frankfort, KY

NPI number1043039704

StatusActive

Last updated in NPPESOct 9, 2024

Details

NPI: 1043039704
Entity type: Organization (NPI-2)
Legal business name: 124 Recovery LLC
Organization subpart: No
Enumeration date: Oct 9, 2024
Certification date: Oct 9, 2024
Last updated: Oct 9, 2024

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
101YA0400X	Counselor, Addiction (Substance Use Disorder)	–	–	Yes
101YM0800X	Counselor, Mental Health	–	–
103TA0400X	Psychologist, Addiction (Substance Use Disorder)	–	–
104100000X	Social Worker	–	–
1041C0700X	Social Worker, Clinical	–	–
171M00000X	Case Manager/Care Coordinator	–	–

Practice location

200 W Broadway St
Frankfort, KY 40601-1933

Phone 502-352-4904

Mailing address

200 W Broadway St
Frankfort, KY 40601-1933

Phone 502-352-4904

Authorized official

Eric Jockers
Owner
5023524904

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