Healthcare Provider Details

I. General information

NPI: 1992148415
Provider Name (Legal Business Name): CHRISTOPHER ALAN KIDD LICSW, CSW, MSSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2013
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 S MAIN CROSS ST
LOUISA KY
41230-1330
US

IV. Provider business mailing address

125 S MAIN CROSS ST
LOUISA KY
41230-1330
US

V. Phone/Fax

Practice location:
  • Phone: 606-638-0938
  • Fax: 859-813-5394
Mailing address:
  • Phone: 606-638-0938
  • Fax: 859-813-5394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number256194
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00944383
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: