Individual
MR. JONATHAN MARCELLAS CARR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
336 LUCILLE DR, LEXINGTON, KY 40511-8796
(859) 619-0684
Mailing address
336 LUCILLE DR, LEXINGTON, KY 40511-8796
(859) 619-0684
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPCCCA00218618
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
725568
—
KY
Enumeration date
08/21/2015
Last updated
05/10/2021
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