Individual
BERNETTA SOUTHWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3830 HIGHWAY 15 S, JACKSON, KY 41339-8675
(606) 666-7591
(606) 666-8364
Mailing address
115 ROCKWOOD LN, HAZARD, KY 41701-9415
(606) 436-5761
(606) 436-5797
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
252579
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100454940
—
KY
Enumeration date
05/14/2014
Last updated
09/19/2023
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