Healthcare Provider Details

I. General information

NPI: 1619569225
Provider Name (Legal Business Name): ALLEY FANESI CHADWELL LISW, LICDC, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLEY FANESI MILLER

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11137 US HIGHWAY 52
BROOKVILLE IN
47012-7901
US

IV. Provider business mailing address

423 FOOTE AVE
BELLEVUE KY
41073-1501
US

V. Phone/Fax

Practice location:
  • Phone: 765-647-5126
  • Fax:
Mailing address:
  • Phone: 859-630-0350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number161867
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34009220A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1801136
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: