Healthcare Provider Details

I. General information

NPI: 1851125058
Provider Name (Legal Business Name): DONNA RUTH MORELAND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3629 CHURCH ST
COVINGTON KY
41015-1430
US

IV. Provider business mailing address

154 HAYES STATION RD
FALMOUTH KY
41040-7941
US

V. Phone/Fax

Practice location:
  • Phone: 859-581-8974
  • Fax:
Mailing address:
  • Phone: 513-410-1021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1041C0700X
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: