Provider Demographics
NPI:1811369390
Name:DOW, MICHAEL (CADC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DOW
Suffix:
Gender:M
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:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:WILLISBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40078-0188
Mailing Address - Country:US
Mailing Address - Phone:859-375-9200
Mailing Address - Fax:859-375-9202
Practice Address - Street 1:2084 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLISBURG
Practice Address - State:KY
Practice Address - Zip Code:40078-8199
Practice Address - Country:US
Practice Address - Phone:859-375-9200
Practice Address - Fax:859-375-9202
Is Sole Proprietor?:No
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0026101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0026OtherCERTIFIED ALCOHOL AND DRUG COUNSELOR
KY80486OtherSUBSTANCE ABUSE PROFESSIONAL