Healthcare Provider Details

I. General information

NPI: 1659004117
Provider Name (Legal Business Name): MORGAN DAVIDSON CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2022
Last Update Date: 07/02/2022
Certification Date: 07/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 GIBSON BAY DR FL 2
RICHMOND KY
40475-3544
US

IV. Provider business mailing address

440 SQUIRES RD APT 4302
LEXINGTON KY
40515-5738
US

V. Phone/Fax

Practice location:
  • Phone: 855-591-0092
  • Fax:
Mailing address:
  • Phone: 606-594-7084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number255084
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: