Active NPI
Rebellious Recovery LLC
- Addiction (Substance Use Disorder) Counselor
- Paducah, KY
National Provider Identifier
1710890470
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- Legal business name
- REBELLIOUS RECOVERY LLC
- Practice address
- 3011 Jefferson St Apt D
Paducah, KY 42001-4373 - Phone
- (270) 392-2375
- NPI assigned
- Sep 24, 2026
- Last updated
- Sep 24, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Stacy Kirkham, LCADC
- Title
- Owner
- Phone
- (270) 392-2375
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | Primary |
Addresses
Primary practice location
3011 Jefferson St Apt D
Paducah, KY 42001-4373
Mailing address
3011 Jefferson St Apt D
Paducah, KY 42001-4373
Phone (270) 392-2375
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1790208000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1790208000000",
"number": "1710890470",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3011 JEFFERSON ST APT D",
"city": "PADUCAH",
"state": "KY",
"postal_code": "420014373",
"telephone_number": "270-392-2375"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3011 JEFFERSON ST APT D",
"city": "PADUCAH",
"state": "KY",
"postal_code": "420014373",
"telephone_number": "270-392-2375"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "REBELLIOUS RECOVERY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2026-09-24",
"last_updated": "2026-09-24",
"certification_date": "2026-09-24",
"status": "A",
"authorized_official_last_name": "KIRKHAM",
"authorized_official_first_name": "STACY",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "270-392-2375",
"authorized_official_credential": "LCADC"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Paducah, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.