Healthcare Provider Details

I. General information

NPI: 1700675105
Provider Name (Legal Business Name): AUDREY FLETCHER CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUDREY HOLBROOK CSW

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 W SUN ST
MOREHEAD KY
40351-1563
US

IV. Provider business mailing address

555 W SUN ST
MOREHEAD KY
40351-1563
US

V. Phone/Fax

Practice location:
  • Phone: 606-783-6805
  • Fax:
Mailing address:
  • Phone: 606-783-6805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number258898
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number258898
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: