Provider Demographics
NPI:1427400977
Name:WATERS, DAVID (LCSW, LCADC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:WATERS
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 1:409 W NEW CIRCLE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-1832
Mailing Address - Country:US
Mailing Address - Phone:859-800-5353
Mailing Address - Fax:859-554-0408
Practice Address - Street 1:409 W NEW CIRCLE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-1832
Practice Address - Country:US
Practice Address - Phone:859-800-5353
Practice Address - Fax:859-554-0408
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-08
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKSWB-5155101YM0800X, 1041C0700X
KYCADCB-165614101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty