Individual
MS. MINA RAE THEVENIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
8521 LAGRANGE RD, LOUISVILLE, KY 40242-3800
(502) 814-3721
(502) 814-3575
Mailing address
P.O. BOX 221083, LOUISVILLE, KY 40241
(502) 814-3721
(502) 814-3575
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1947
KY
Other
Enumeration date
07/23/2006
Last updated
07/08/2007
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