Provider Demographics
NPI:1891464913
Name:KINCHELOE, CHERRY BROOKE
Entity Type:Individual
Prefix:
First Name:CHERRY
Middle Name:BROOKE
Last Name:KINCHELOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 BETH LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3416
Mailing Address - Country:US
Mailing Address - Phone:502-594-3715
Mailing Address - Fax:
Practice Address - Street 1:1031 WELLINGTON WAY STE 265
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1256
Practice Address - Country:US
Practice Address - Phone:859-229-8222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2551131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical