Healthcare Provider Details

I. General information

NPI: 1275014177
Provider Name (Legal Business Name): CHARLENE SCITES-THOMPSON LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CUNNINGHAM WAY
DANVILLE KY
40422-8342
US

IV. Provider business mailing address

300 HOPE ST
MT WASHINGTON KY
40047-7757
US

V. Phone/Fax

Practice location:
  • Phone: 859-936-3513
  • Fax: 859-936-3541
Mailing address:
  • Phone: 502-538-1000
  • Fax: 502-538-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number104679
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: