Provider Demographics
NPI:1033741947
Name:ARMISTEAD, ANNEMARIE LUCILE
Entity Type:Individual
Prefix:
First Name:ANNEMARIE
Middle Name:LUCILE
Last Name:ARMISTEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 S GRIFFITH AVE
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-6852
Mailing Address - Country:US
Mailing Address - Phone:270-993-4109
Mailing Address - Fax:270-684-6748
Practice Address - Street 1:3808 S GRIFFITH AVE
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-6852
Practice Address - Country:US
Practice Address - Phone:270-684-2598
Practice Address - Fax:270-684-6748
Is Sole Proprietor?:No
Enumeration Date:2020-02-08
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY103799101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health