Individual
MR. JOHNATHAN LUCAS BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADCA I
Contact information
Practice address
1675 STORY AVE, LOUISVILLE, KY 40206-1739
(502) 749-6344
(502) 749-6344
Mailing address
1675 STORY AVE, LOUISVILLE, KY 40206-1739
(502) 749-6344
(502) 749-6344
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
301969
KY
376K00000X
Nurse's Aide
4035841
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
301969
CADCA
KY
01
—
4035841
SRNA
KY
Enumeration date
01/14/2026
Last updated
01/14/2026
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