Individual
DAIQUIRI FALLON AMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCC-S
Contact information
Practice address
4537 LARGO LN, LEXINGTON, KY 40515-5124
(859) 279-2031
Mailing address
4537 LARGO LN, LEXINGTON, KY 40515-5124
(859) 279-2031
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
171234
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30610026
—
KY
05
—
7100450240
—
KY
Enumeration date
01/24/2014
Last updated
06/05/2026
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