Provider Demographics
NPI:1821480187
Name:BROCK, CECILIA (CADC)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:
Last Name:BROCK
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:967 US HIGHWAY 25 W
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-4543
Mailing Address - Country:US
Mailing Address - Phone:606-526-9348
Mailing Address - Fax:606-526-1541
Practice Address - Street 1:967 US HIGHWAY 25 W
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-4543
Practice Address - Country:US
Practice Address - Phone:606-526-9348
Practice Address - Fax:606-526-1541
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0420101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)