Provider Demographics
NPI:1427755073
Name:ACHESON, KYLIENE MICHELLE (LADAC II)
Entity type:Individual
Prefix:
First Name:KYLIENE
Middle Name:MICHELLE
Last Name:ACHESON
Suffix:
Gender:F
Credentials:LADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 HIGHWAY 12 S UNIT 33
Mailing Address - Street 2:
Mailing Address - City:ASHLAND CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37015-3937
Mailing Address - Country:US
Mailing Address - Phone:615-995-2746
Mailing Address - Fax:
Practice Address - Street 1:2121 HIGHWAY 12 S UNIT 33
Practice Address - Street 2:
Practice Address - City:ASHLAND CITY
Practice Address - State:TN
Practice Address - Zip Code:37015-3937
Practice Address - Country:US
Practice Address - Phone:615-995-2746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001190101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)