Healthcare Provider Details

I. General information

NPI: 1578349841
Provider Name (Legal Business Name): CDSTHERAPEUTICCOUNSELINGCMS@GMAIL.COM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2023
Last Update Date: 09/04/2023
Certification Date: 09/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4726 VAN HOOSE RD
LOUISVILLE KY
40216-2951
US

IV. Provider business mailing address

1213 ORMSBY LN
LOUISVILLE KY
40222-3862
US

V. Phone/Fax

Practice location:
  • Phone: 502-767-6220
  • Fax:
Mailing address:
  • Phone: 502-417-9505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: CARLA ANN DELONG
Title or Position: FOUNDER
Credential:
Phone: 502-417-9505