Individual
CAROLYN L IVERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
404 STEVE DR, RUSSELL SPRINGS, KY 42642
(270) 866-3161
(270) 866-3163
Mailing address
PO BOX 1080, BURKESVILLE, KY 42717-1080
(270) 858-6655
(270) 858-4027
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
KY
1041C0700X
Clinical Social Worker
Primary
258227
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15989827
CAQH
KY
05
—
7100923660
—
KY
Enumeration date
09/08/2021
Last updated
08/28/2024
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