Provider Demographics
NPI:1962771691
Name:LIVESAY, DORINDA LAFON (LPCA)
Entity type:Individual
Prefix:
First Name:DORINDA
Middle Name:LAFON
Last Name:LIVESAY
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:DORINDA
Other - Middle Name:LAFON
Other - Last Name:CHERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1771 OLD HARTSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42164-9342
Mailing Address - Country:US
Mailing Address - Phone:270-622-7136
Mailing Address - Fax:
Practice Address - Street 1:608 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:KY
Practice Address - Zip Code:42134-2329
Practice Address - Country:US
Practice Address - Phone:270-586-4645
Practice Address - Fax:270-586-4647
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1265101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health