Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | KY-0583 | KY |
NPI | 1770099749 |
---|---|
Provider Name | Audrey Mcdonald Carney |
First Address | Lebanon Jct, KY 40150-8567 |
Second Address | Lebanon Jct, KY 40150-8567 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2017 |
Last Update Date | 19/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101Y00000X | (05) | KY |