Individual
ANNE C FAJARDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
620 S 3RD ST STE 102, LOUISVILLE, KY 40202-2445
(502) 767-6407
Mailing address
9905 BLUE LICK RD, LOUISVILLE, KY 40229-1843
(502) 593-6062
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
10/18/2021
Last updated
10/18/2021
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