Healthcare Provider Details

I. General information

NPI: 1427074301
Provider Name (Legal Business Name): DEWEY RAINS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 STEVE DR STE 102
RUSSELL SPRINGS KY
42642-4622
US

IV. Provider business mailing address

PO BOX 1080
BURKESVILLE KY
42717-1080
US

V. Phone/Fax

Practice location:
  • Phone: 606-866-3161
  • Fax: 606-866-3163
Mailing address:
  • Phone: 606-676-0638
  • Fax: 606-676-0789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1193
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: