MEDICARE: CRASHONDA DUNCAN MFTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	263584	KY
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	170577	KY
3	106H00000X	Marriage & Family Therapist	263584	KY

General Provider Information

NPI Number	:	1336641398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRASHONDA DUNCAN MFTA

Provider Business Mailing Address
First Line	:	4420 TARA AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40216-3047
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 BARRET AVE STE 222
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40204-1733
Country	:	US
Telephone Number	:	502-489-4007
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2018
Last Update Date	:	07/03/2024

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