Provider Demographics
NPI:1083298277
Name:RIFFELL, KENNETH ROY (LMFT)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:ROY
Last Name:RIFFELL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CORPORATE CENTER CT UNIT 200-A
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-2033
Mailing Address - Country:US
Mailing Address - Phone:336-687-7888
Mailing Address - Fax:
Practice Address - Street 1:5 CORPORATE CENTER CT UNIT 200-A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-2033
Practice Address - Country:US
Practice Address - Phone:336-293-7406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12305A106H00000X
NC2551101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist