Provider Demographics
NPI:1780414458
Name:WAFORD, MICHELLE DARLENE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DARLENE
Last Name:WAFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DARLENE
Other - Middle Name:
Other - Last Name:WAFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:80 TRIPLE D DR
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40071-9222
Mailing Address - Country:US
Mailing Address - Phone:502-594-1434
Mailing Address - Fax:
Practice Address - Street 1:600 RODEO DR
Practice Address - Street 2:
Practice Address - City:ERLANGER
Practice Address - State:KY
Practice Address - Zip Code:41018-1279
Practice Address - Country:US
Practice Address - Phone:502-594-1434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional