Healthcare Provider Details

I. General information

NPI: 1679644967
Provider Name (Legal Business Name): COUNSELING AND DIAGNOSTIC CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
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 TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateKY
# 7
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateKY

VIII. Authorized Official

Name: DR. THOMAS CRATON NOYES
Title or Position: MANAGING PARTNER
Credential: PHD
Phone: 859-282-0119