Provider Demographics
NPI:1700675105
Name:FLETCHER, AUDREY (CSW)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:
Other - Last Name:HOLBROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:555 W SUN ST
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1563
Mailing Address - Country:US
Mailing Address - Phone:606-783-6805
Mailing Address - Fax:
Practice Address - Street 1:555 W SUN ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1563
Practice Address - Country:US
Practice Address - Phone:606-783-6805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY258898101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)