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Active
Organization subpart
No

Provider details

NPI number
Authorized official
MICHELLE KUNICK LCSW (OWNER)
(859) 407-2233
Entity
Organization

Contact information

Practice address
3175 CUSTER DR STE 100, LEXINGTON, KY 40517-4023
(859) 407-2233
(859) 448-5235
Mailing address
3175 CUSTER DR STE 100, LEXINGTON, KY 40517-4023
(859) 407-2233
(859) 448-5235

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7100742690
KY
Enumeration date
12/15/2021
Last updated
04/02/2025
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