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General NPI Number Information
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NPI Number | 1891237442
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Entity Type | Organization
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Legal Business Name | AD ASTRA COLLABORATIVE THERAPY
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Dates
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Enumeration Date | 11/14/2016
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Last Update Date | 02/22/2024
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Provider Practice Location Address
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Address Line | 940 WILLARDS LANE
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City | BRANDENBURG
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State | KY
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Zip | 40108
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Country | US
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Telephone | 502-203-9197
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Fax |
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Provider Business Mailing Address
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Address Line | 940 WILLARDS LANE
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City | BRANDENBURG
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State | KY
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Zip | 40108
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Country | US
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Telephone | 502-203-9197
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Fax |
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Authorized Official
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Title or Position | THERAPIST - OWNER
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Name | MS. JENNIFER KENDRICK
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Credential | LCSW, LMFT
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Telephone | 502-203-9197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 104353
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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