Provider Demographics
NPI:1104545193
Name:DOAN, ANISSA MICHELLE
Entity type:Individual
Prefix:
First Name:ANISSA
Middle Name:MICHELLE
Last Name:DOAN
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 1:5971 POOR BOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:ELKHORN CITY
Mailing Address - State:KY
Mailing Address - Zip Code:41522-8150
Mailing Address - Country:US
Mailing Address - Phone:606-273-8131
Mailing Address - Fax:
Practice Address - Street 1:5971 POOR BOTTOM RD
Practice Address - Street 2:
Practice Address - City:ELKHORN CITY
Practice Address - State:KY
Practice Address - Zip Code:41522-8150
Practice Address - Country:US
Practice Address - Phone:606-273-8131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY291037101YP2500X
KY289931101YA0400X
KY276135101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)