Individual
MARVIN CARL KIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
274 SOUTHLAND DR, SUITE # 204, LEXINGTON, KY 40503-1946
(859) 457-1679
(859) 278-3451
Mailing address
2145 LARKSPUR DR, LEXINGTON, KY 40504-3501
(859) 457-1679
(859) 278-3451
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
MH8993
FL
101YP2500X
Professional Counselor
Primary
KY-1058
KY
1041C0700X
Clinical Social Worker
MH8993
FL
Other
Enumeration date
01/14/2008
Last updated
12/14/2011
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