Individual
DR. GERALDINE BAKER CRADDOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.MIN., LCADC, LPC
Contact information
Practice address
1588 HILL RISE DR, LEXINGTON, KY 40504-2587
(859) 255-0890
(859) 255-0854
Mailing address
1588 HILL RISE DR, LEXINGTON, KY 40504-2587
(859) 255-0890
(859) 255-0854
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
ADCLAD00225185
KY
324500000X
Substance Abuse Rehabilitation Facility
KY-0001
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083982185
—
KY
Enumeration date
12/05/2011
Last updated
04/13/2016
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