Individual
BRENNAN VALLENCOURT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
325 PROFESSIONAL AVE, WINCHESTER, KY 40391-1179
(859) 744-2562
Mailing address
650 S MILL ST, APT. 313, LEXINGTON, KY 40508-2983
(904) 309-2700
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
KY1695
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790731081
—
KY
Enumeration date
09/24/2014
Last updated
10/06/2014
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