Healthcare Provider Details

I. General information

NPI: 1275306409
Provider Name (Legal Business Name): ALEXIS DANIELLE DUNHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2023
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7426 US HIGHWAY 42 STE 106
FLORENCE KY
41042-2056
US

IV. Provider business mailing address

7426 US HIGHWAY 42 STE 106
FLORENCE KY
41042-2056
US

V. Phone/Fax

Practice location:
  • Phone: 859-282-0119
  • Fax: 859-282-8018
Mailing address:
  • Phone: 859-282-0119
  • Fax: 859-282-8018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number308400
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: