Individual
STACI CASE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCA
Contact information
Practice address
110 E. MAIN ST. SUITE 111, GEORGETOWN, KY 40324
(859) 553-4406
Mailing address
PO BOX 1644, GEORGETOWN, KY 40324
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
175344
KY
Other
Enumeration date
02/06/2018
Last updated
02/06/2018
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