Provider Demographics
NPI:1043472996
Name:THIGPEN, KENNETTE RENEE (MSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:KENNETTE
Middle Name:RENEE
Last Name:THIGPEN
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27894-0111
Mailing Address - Country:US
Mailing Address - Phone:252-916-1061
Mailing Address - Fax:252-234-7140
Practice Address - Street 1:114 N SPRUCE ST
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27894-0111
Practice Address - Country:US
Practice Address - Phone:252-916-1061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0060711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical