Individual
AMANDA L BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMFT, CADC
Contact information
Practice address
401 E CHESTNUT ST, SUITE 610, LOUISVILLE, KY 40202-5700
(502) 813-6600
Mailing address
401 E CHESTNUT ST, SUITE 610, LOUISVILLE, KY 40202-5700
(502) 813-6600
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1106
KY
106H00000X
Marriage & Family Therapist
Primary
0824
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0824
LICNESED MARRIAGE AND FAMILY THERAPIST
KY
01
—
1106
CERTIFIED ALCOHOL AND ADDICTION COUNSELOR
KY
Enumeration date
06/08/2010
Last updated
12/11/2013
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