Healthcare Provider Details

I. General information

NPI: 1518984335
Provider Name (Legal Business Name): CURTIS ALAN DELOACH L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W MOUNT VERNON ST SUITE 100
SOMERSET KY
42501-1673
US

IV. Provider business mailing address

207 W MOUNT VERNON ST SUITE 100
SOMERSET KY
42501-1673
US

V. Phone/Fax

Practice location:
  • Phone: 606-679-1528
  • Fax: 606-677-0867
Mailing address:
  • Phone: 606-679-1528
  • Fax: 606-677-0867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number991
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: