Provider Demographics
NPI:1710669684
Name:CARSON, JEANIE (LCADC)
Entity Type:Individual
Prefix:MRS
First Name:JEANIE
Middle Name:
Last Name:CARSON
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 OLD SOLDIER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KIRKSEY
Mailing Address - State:KY
Mailing Address - Zip Code:42054-9117
Mailing Address - Country:US
Mailing Address - Phone:270-489-2594
Mailing Address - Fax:270-489-2574
Practice Address - Street 1:1250 OLD SOLDIER CREEK RD
Practice Address - Street 2:
Practice Address - City:KIRKSEY
Practice Address - State:KY
Practice Address - Zip Code:42054-9117
Practice Address - Country:US
Practice Address - Phone:270-489-2594
Practice Address - Fax:270-489-2574
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY168056101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)