Provider Demographics
NPI:1255460424
Name:DEWITT, WILLIAM A (LMHC, LPC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:DEWITT
Suffix:
Gender:M
Credentials:LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 CHAMBERLIN AVE.
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40342
Mailing Address - Country:US
Mailing Address - Phone:859-214-1686
Mailing Address - Fax:502-875-1686
Practice Address - Street 1:649 CHAMBERLIN AVE.
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342
Practice Address - Country:US
Practice Address - Phone:859-214-1686
Practice Address - Fax:502-875-1686
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2024-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005905101YM0800X
KY284449101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA910598103OtherTAX IDENTIFICATION NUMBER