Basic Information
| Provider Information | |||||||||
| NPI: | 1326082819 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUCKABY | ||||||||
| FirstName: | BRENDA | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 SOUTHERN SCHOOL RD | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | KY | ||||||||
| PostalCode: | 425013223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066794782 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 E FRAZIER AVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427281915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703844710 | ||||||||
| FaxNumber: | 2703844820 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 04/30/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 3000 | KY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.