Provider Demographics
NPI:1083485643
Name:KENNEDY, CAITLIN (MSW, LCAS-A)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MSW, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LONG SHOALS RD APT 11F
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-7751
Mailing Address - Country:US
Mailing Address - Phone:336-309-1149
Mailing Address - Fax:
Practice Address - Street 1:3 DOCTORS PARK STE G
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4521
Practice Address - Country:US
Practice Address - Phone:828-251-1478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)