Facts
- Status
- A
- Credential
- LCSW, LCADC
- Type
- Individual
- Enumeration date
- 2023-01-16
- Last updated
- 2024-03-29
Licenses
- License KY
- 269647
- License KY
- 256237
Location
- Practice location
- 501 WASHBURN AVE
- City
- LYNDON KY
- Postal code
- 402224725
- Phone
- 502-625-5265
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.