Provider Demographics
NPI:1477896454
Name:GITTINGS, MISTY DAWN (LCSW)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:DAWN
Last Name:GITTINGS
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 1:950 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203
Mailing Address - Country:US
Mailing Address - Phone:502-585-9444
Mailing Address - Fax:502-589-4489
Practice Address - Street 1:950 S 1ST ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203
Practice Address - Country:US
Practice Address - Phone:502-585-9444
Practice Address - Fax:502-589-4489
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY254157104100000X
171M00000X
KY2562401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator