Provider Demographics
NPI:1093480535
Name:CONLEY, KATHINA FAITH (LPCA)
Entity Type:Individual
Prefix:
First Name:KATHINA
Middle Name:FAITH
Last Name:CONLEY
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1589 HILL RISE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2588
Mailing Address - Country:US
Mailing Address - Phone:859-977-2501
Mailing Address - Fax:
Practice Address - Street 1:1589 HILL VIEW PL APT 1104
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2594
Practice Address - Country:US
Practice Address - Phone:859-977-2501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY262613101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)