Provider Demographics
NPI:1336703867
Name:SOCIALBUG INTEGRATED COUNSELING SERVICES, INC.
Entity Type:Organization
Organization Name:SOCIALBUG INTEGRATED COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-641-7828
Mailing Address - Street 1:2438 PADDOCK LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-2344
Mailing Address - Country:US
Mailing Address - Phone:502-641-7828
Mailing Address - Fax:
Practice Address - Street 1:6801 DIXIE HWY STE 232
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40258-3962
Practice Address - Country:US
Practice Address - Phone:502-641-7828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty