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Individual

DERRICK JASON CHANEY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
BSW

Contact information

Practice address
1351 NEWTOWN PIKE, LEXINGTON, KY 40511-1275
(859) 253-1686
Mailing address
1351 NEWTOWN PIKE, LEXINGTON, KY 40511-1275
(859) 253-1686

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
KY
104100000X
Social Worker
Primary
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1790731081
KY
05
NA
KY
Enumeration date
09/05/2019
Last updated
03/22/2022
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