Healthcare Provider Details

I. General information

NPI: 1467756916
Provider Name (Legal Business Name): MONICA LYNN HIMES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2010
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N COLONIAL HEIGHTS DR
GEORGETOWN KY
40324-2569
US

IV. Provider business mailing address

111 N COLONIAL HEIGHTS DR
GEORGETOWN KY
40324-2569
US

V. Phone/Fax

Practice location:
  • Phone: 859-421-3079
  • Fax:
Mailing address:
  • Phone: 859-421-3079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1137
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3871
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: