Lake Substance Abuse Solutions LLC
NPI 1124598669 · Psychiatric/Mental Health Nurse Practitioner · Jeffersonville, IN
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Provider details
- NPI number
- 1124598669
- Entity type
- Organization
- Primary specialty
- Psychiatric/Mental Health Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Organization subpart
- No
- Authorized official
- David Corddry, Owner(407) 622-8086
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
- Psychologist103T00000X
Behavioral Health & Social Service Providers
Behavioral Health & Social Service Providers
Nursing Service Providers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
7 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
3 documented practice locations
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Additional practice locations (2)
- 225 W Canton Ave Ste 600Winter Park, FL 32789-3181Phone: (833) 525-3727
- 1143 Fairway St Unit 110Bowling Green, KY 42103-2452Phone: (833) 525-3727
Registry dates
- Enumerated
- 2018-11-27
- Last updated
- 2025-09-02
- Certified
- 2025-09-02
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.