Provider Demographics
NPI:1659521920
Name:COMMONWEALTH SUBSTANCE ABUSE SPECIALIST
Entity Type:Organization
Organization Name:COMMONWEALTH SUBSTANCE ABUSE SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:TONER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:859-371-4455
Mailing Address - Street 1:7000 HOUSTON RD
Mailing Address - Street 2:BLDG. 400, SUITE, 43
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-4873
Mailing Address - Country:US
Mailing Address - Phone:859-371-4455
Mailing Address - Fax:859-371-2454
Practice Address - Street 1:7000 HOUSTON RD
Practice Address - Street 2:BLDG. 400, SUITE, 43
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4873
Practice Address - Country:US
Practice Address - Phone:859-371-4455
Practice Address - Fax:859-371-2454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP-45252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency