Provider Demographics
NPI:1437661899
Name:DEATON, MARK (LPCC, LCADC, PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:DEATON
Suffix:
Gender:M
Credentials:LPCC, LCADC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-1247
Mailing Address - Country:US
Mailing Address - Phone:502-803-7445
Mailing Address - Fax:502-470-3572
Practice Address - Street 1:1100 US HIGHWAY 127 S STE C4
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4325
Practice Address - Country:US
Practice Address - Phone:502-803-7445
Practice Address - Fax:502-470-3572
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYADCADT00222882101YA0400X
KY240673101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)