Provider Demographics
NPI:1942336037
Name:DRAWBRIGES COUNSELING SERVICES
Entity Type:Organization
Organization Name:DRAWBRIGES COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STATE EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:DWYRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-225-9199
Mailing Address - Street 1:10304 SPOTSYLVANIA AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-8602
Mailing Address - Country:US
Mailing Address - Phone:540-710-6085
Mailing Address - Fax:540-710-6447
Practice Address - Street 1:7410 NEW LAGRANGE RD
Practice Address - Street 2:STE 320
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4871
Practice Address - Country:US
Practice Address - Phone:502-225-9199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY29200185Medicaid