Individual
MR. HENRY FUQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC
Contact information
Practice address
1675 STORY AVE, LOUISVILLE, KY 40206-1739
(502) 749-6344
(502) 749-6344
Mailing address
1675 STORY AVE, LOUISVILLE, KY 40206-1739
(502) 749-6344
(502) 749-6344
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
119050
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
119050
CERTIFIED ALCOHOL & DRUG CONSOLER LICENSE #
KY
Enumeration date
01/14/2025
Last updated
01/14/2025
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