Provider Demographics
NPI:1780405779
Name:LEDFORD, KEVIN LUCAS (MS, NCC, LADAC II)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:LUCAS
Last Name:LEDFORD
Suffix:
Gender:M
Credentials:MS, NCC, LADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 MERRYWOOD GLN APT 3
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-5065
Mailing Address - Country:US
Mailing Address - Phone:901-486-1155
Mailing Address - Fax:
Practice Address - Street 1:37 SANDSTONE CIR STE 92
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3168
Practice Address - Country:US
Practice Address - Phone:731-265-6025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1713101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)