Provider Demographics
NPI:1003145145
Name:CURTIS, MICHELLE R (LCAC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:CURTIS
Suffix:
Gender:F
Credentials:LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 W BROADWAY STE 202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3245
Mailing Address - Country:US
Mailing Address - Phone:502-561-0943
Mailing Address - Fax:502-561-0944
Practice Address - Street 1:1700 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4916
Practice Address - Country:US
Practice Address - Phone:812-914-7038
Practice Address - Fax:812-748-6035
Is Sole Proprietor?:No
Enumeration Date:2009-12-21
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000393A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)