Provider Demographics
NPI:1174645337
Name:DAVIDSON, ANDREW M (LCSW,LCADC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:M
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:LCSW,LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2128
Mailing Address - Country:US
Mailing Address - Phone:502-387-9074
Mailing Address - Fax:
Practice Address - Street 1:1387 LEXINGTON RD FRNT HOUSE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1926
Practice Address - Country:US
Practice Address - Phone:502-387-9074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35491041C0700X
KYADCLAD00225188101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)