=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104412907
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMBRACE COUNSELING AND CONSULTING SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2020
-----------------------------------------------------
Last Update Date | 12/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2108 BARDSTOWN RD
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40205-1985
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-819-6734
-----------------------------------------------------
Fax | 502-371-6377
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1405 JUNIPER DR APT 3
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40222-7891
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-819-6734
-----------------------------------------------------
Fax | 502-371-6377
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL THERAPIST/DIRECTOR
-----------------------------------------------------
Name | CYNTHIA D. FLETCHER
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 502-819-6734
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------