Provider Demographics
NPI:1487283883
Name:LADWIG, CRAIG MATTHEW (LPCC)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:MATTHEW
Last Name:LADWIG
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:MATT
Other - Middle Name:
Other - Last Name:LADWIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1351 NEWTOWN PIKE BLDG 1
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-1277
Mailing Address - Country:US
Mailing Address - Phone:859-253-1686
Mailing Address - Fax:
Practice Address - Street 1:135 E MAXWELL ST STE 200
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2622
Practice Address - Country:US
Practice Address - Phone:859-323-6211
Practice Address - Fax:859-257-9821
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY172V00000X
KY288482101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid