Provider Demographics
NPI:1205496825
Name:LOCKHART-KIDD, HOLLY NICOLE (MED, LPCC, NCC)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:NICOLE
Last Name:LOCKHART-KIDD
Suffix:
Gender:F
Credentials:MED, LPCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 BOGLE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2850
Mailing Address - Country:US
Mailing Address - Phone:606-516-8077
Mailing Address - Fax:
Practice Address - Street 1:34 FARM RIDGE RD
Practice Address - Street 2:
Practice Address - City:STEARNS
Practice Address - State:KY
Practice Address - Zip Code:42647-6171
Practice Address - Country:US
Practice Address - Phone:606-376-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY248146101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional