Provider Demographics
NPI:1922453489
Name:SHIRLEY, ANNA (LCADC LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:
Last Name:SHIRLEY
Suffix:
Gender:F
Credentials:LCADC LCSW
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1090 INDUSTRY RD
Mailing Address - Street 2:
Mailing Address - City:HARRODSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40330-9140
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1090 INDUSTRY RD
Practice Address - Street 2:
Practice Address - City:HARRODSBURG
Practice Address - State:KY
Practice Address - Zip Code:40330-9140
Practice Address - Country:US
Practice Address - Phone:859-406-5535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY273033101YA0400X
KY253383104100000X
KY2571281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker