Provider Demographics
NPI:1316564065
Name:DUNAWAY, ANNISHA LAUREN (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNISHA
Middle Name:LAUREN
Last Name:DUNAWAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 DOE VALLEY PKWY E
Mailing Address - Street 2:
Mailing Address - City:BRANDENBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40108-8023
Mailing Address - Country:US
Mailing Address - Phone:254-458-5672
Mailing Address - Fax:
Practice Address - Street 1:3805 DOE VALLEY PKWY E
Practice Address - Street 2:
Practice Address - City:BRANDENBURG
Practice Address - State:KY
Practice Address - Zip Code:40108-8023
Practice Address - Country:US
Practice Address - Phone:254-458-5672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0158781041C0700X
DEQ1-00122521041C0700X
VA09040117701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical