Healthcare Provider Details

I. General information

NPI: 1114684586
Provider Name (Legal Business Name): CAROLYN COLLINS LINDSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2021
Last Update Date: 01/01/2025
Certification Date: 01/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 S HURSTBOURNE PKWY STE 105
LOUISVILLE KY
40222-5757
US

IV. Provider business mailing address

2007 LAKELAND RD
LOUISVILLE KY
40223-1205
US

V. Phone/Fax

Practice location:
  • Phone: 502-938-5582
  • Fax:
Mailing address:
  • Phone: 502-938-5582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number266724
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number255715
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: