Healthcare Provider Details

I. General information

NPI: 1043360381
Provider Name (Legal Business Name): LORA ANN MILLSAPS DSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORA ANN DAVIS-SCHUBERT

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 MADISON AVE
COVINGTON KY
41011-1562
US

IV. Provider business mailing address

502 FARRELL DR
COVINGTON KY
41011-3717
US

V. Phone/Fax

Practice location:
  • Phone: 859-331-3292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW003455
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1970
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: