Healthcare Provider Details

I. General information

NPI: 1093995649
Provider Name (Legal Business Name): RACHELLE HENSON GARDNER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2073 BELMONT DR
LEXINGTON KY
40516-9685
US

IV. Provider business mailing address

2073 BELMONT DR
LEXINGTON KY
40516-9685
US

V. Phone/Fax

Practice location:
  • Phone: 859-433-0556
  • Fax:
Mailing address:
  • Phone: 859-433-0556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW00001650
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: