Healthcare Provider Details

I. General information

NPI: 1780148353
Provider Name (Legal Business Name): SOUTHLAND CHILD, ADULT, AND FAMILY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 CLAYS MILL RD STE 109
LEXINGTON KY
40503-3484
US

IV. Provider business mailing address

3320 CLAYS MILL RD STE 109
LEXINGTON KY
40503-3484
US

V. Phone/Fax

Practice location:
  • Phone: 859-285-2959
  • Fax: 859-838-1092
Mailing address:
  • Phone: 859-285-2959
  • Fax: 859-838-1092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JESSICA JARAMILLO
Title or Position: LCSW/OWNER
Credential: LCSW
Phone: 859-285-2959