Individual
MIA G PERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1236 PARIS PIKE, GEORGETOWN, KY 40324-9701
(502) 370-7229
Mailing address
2385 RANDOLPH CT, LEXINGTON, KY 40503-2620
(215) 605-5373
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
5032
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790731081
—
KY
Enumeration date
10/05/2012
Last updated
01/12/2018
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