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General NPI Number Information
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NPI Number | 1265500664
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Entity Type | Individual
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Provider Name | GINA MICHELE UNDERWOOD L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4 PHYSICIANS PARK
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City | FRANKFORT
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State | KY
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Zip | 40601-4181
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Country | US
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Telephone | 502-875-1685
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Fax | 502-875-1686
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Provider Business Mailing Address
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Address Line | 614 CENTRAL AVE APT 4
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City | LEXINGTON
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State | KY
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Zip | 40502-1793
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Country | US
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Telephone | 859-227-4676
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Fax | 502-875-1686
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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 | KY1630
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License Number State | KY
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