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General NPI Number Information
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NPI Number | 1174645337
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Entity Type | Individual
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Provider Name | ANDREW M DAVIDSON LCSW,LCADC
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Gender | Male
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 03/08/2018
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Provider Practice Location Address
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Address Line | 1387 LEXINGTON RD FRNT HOUSE
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City | LOUISVILLE
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State | KY
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Zip | 40206-1926
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Country | US
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Telephone | 502-387-9074
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Fax |
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Provider Business Mailing Address
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Address Line | 2021 LAKESIDE DR
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City | LOUISVILLE
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State | KY
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Zip | 40205-2128
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Country | US
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Telephone | 502-387-9074
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3549
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ADCLAD00225188
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License Number State | KY
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