Provider Demographics
NPI:1811233620
Name:GADDIE, CARI LEE (LPCC)
Entity Type:Individual
Prefix:
First Name:CARI
Middle Name:LEE
Last Name:GADDIE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1011
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-1011
Mailing Address - Country:US
Mailing Address - Phone:270-864-1625
Mailing Address - Fax:
Practice Address - Street 1:301 KEEN STREET
Practice Address - Street 2:
Practice Address - City:BURKESVILLE
Practice Address - State:KY
Practice Address - Zip Code:42717-1011
Practice Address - Country:US
Practice Address - Phone:270-864-1625
Practice Address - Fax:270-864-1624
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY165135101YP2500X
KYLPCPCC00223778101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional