Healthcare Provider Details

I. General information

NPI: 1033691035
Provider Name (Legal Business Name): THIN LINE COUNSELING AND CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 E REYNOLDS RD STE B6
LEXINGTON KY
40517-1279
US

IV. Provider business mailing address

228 E REYNOLDS RD STE B6
LEXINGTON KY
40517-1279
US

V. Phone/Fax

Practice location:
  • Phone: 800-464-1958
  • Fax:
Mailing address:
  • Phone: 800-464-1958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. TREVOR WILKINS
Title or Position: OWNER
Credential: MA, LPCC
Phone: 859-429-7015