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General NPI Number Information
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NPI Number | 1275649469
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Entity Type | Organization
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Legal Business Name | ADVANCED SOLUTIONS OF CENTRAL KENTUCKY LLC
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 1018 E NEW CIRCLE RD STE 204
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City | LEXINGTON
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State | KY
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Zip | 40505-4138
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Country | US
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Telephone | 859-684-5669
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Fax |
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Provider Business Mailing Address
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Address Line | 1018 E NEW CIRCLE RD STE 204
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City | LEXINGTON
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State | KY
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Zip | 40505-4138
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Country | US
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Telephone | 859-684-5669
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | LLOYD DALLAS JACKSON
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Credential | L.C.S.W.
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Telephone | 859-684-5669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1878
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License Number State | KY
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