Individual
MS. TARAH JEAN KIDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
65 N HIGHWAY 25 W, WILLIAMSBURG, KY 40769-1540
(606) 549-0123
Mailing address
PO BOX 1721, LA FOLLETTE, TN 37766-1721
(859) 755-6871
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0701008317
VA
101YP2500X
Professional Counselor
Primary
243668
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164757399
—
KY
05
—
40588671
—
TN
Enumeration date
10/06/2009
Last updated
03/07/2023
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