Provider Demographics
NPI:1275947905
Name:WKDA SERVICES LLC
Entity Type:Organization
Organization Name:WKDA SERVICES LLC
Other - Org Name:WEST KENTUCKY DRUG & ALCOHOL INTERVENTION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROGRAM ADMINSTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:270-247-4212
Mailing Address - Street 1:1325 U S HWY 45N
Mailing Address - Street 2:P O BOX 374
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066
Mailing Address - Country:US
Mailing Address - Phone:270-247-4212
Mailing Address - Fax:270-247-2017
Practice Address - Street 1:1325 U S HWY 45N
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066
Practice Address - Country:US
Practice Address - Phone:270-247-4212
Practice Address - Fax:270-247-2017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8100025251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health