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General NPI Number Information
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NPI Number | 1710494414
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Entity Type | Organization
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Legal Business Name | WILLOW COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 01/03/2018
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Last Update Date | 06/08/2022
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Provider Practice Location Address
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Address Line | 562 N DIXIE BLVD # B4
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City | RADCLIFF
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State | KY
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Zip | 40160-1366
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Country | US
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Telephone | 270-317-1318
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Fax |
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Provider Business Mailing Address
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Address Line | 1019 FAIRVIEW AVE
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City | RADCLIFF
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State | KY
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Zip | 40160-2407
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER/THERAPIST
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Name | AMANDA LACEFIELD
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Credential | LPCC-S
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Telephone | 270-363-7513
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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 |
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License Number State |
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