Individual
GINA MICHELE UNDERWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.C.S.W.
Contact information
Practice address
4 PHYSICIANS PARK, FRANKFORT, KY 40601-4181
(502) 875-1685
(502) 875-1686
Mailing address
614 CENTRAL AVE APT 4, LEXINGTON, KY 40502-1793
(859) 227-4676
(502) 875-1686
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
KY1630
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000336984
ANTHEM BC BS ID #
KY
01
—
1216008
CHA HEALTH ID #
KY
01
—
611469160
TAX ID & HUMANA&BGFH ID #
KY
01
—
7495652
AETNA PROVIDER ID #
KY
01
—
775407000
MAGELLAN BEH HEALTH ID #
KY
Enumeration date
12/01/2006
Last updated
07/08/2007
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