Healthcare Provider Details

I. General information

NPI: 1255460424
Provider Name (Legal Business Name): WILLIAM A DEWITT LMHC, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 11/03/2024
Certification Date: 11/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

649 CHAMBERLIN AVE.
LAWRENCEBURG KY
40342
US

IV. Provider business mailing address

649 CHAMBERLIN AVE.
LAWRENCEBURG KY
40342
US

V. Phone/Fax

Practice location:
  • Phone: 859-214-1686
  • Fax: 502-875-1686
Mailing address:
  • Phone: 859-214-1686
  • Fax: 502-875-1686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00005905
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number284449
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: