Provider Demographics
NPI:1467190314
Name:CONWAY, LAURA LYNN (TCADC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:CONWAY
Suffix:
Gender:F
Credentials:TCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 TALL TREES CT
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-9719
Mailing Address - Country:US
Mailing Address - Phone:502-229-6057
Mailing Address - Fax:
Practice Address - Street 1:539 MAPLE ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-1943
Practice Address - Country:US
Practice Address - Phone:502-229-6057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY265884101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)