Provider Demographics
NPI:1093279606
Name:KENNEDY, ANNA (MS, LMHC, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MS, LMHC, LPC, NCC
Other - Prefix:
Other - First Name:ANNA CATHERINE
Other - Middle Name:
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:811 EDMOND AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-6342
Mailing Address - Country:US
Mailing Address - Phone:850-363-4269
Mailing Address - Fax:
Practice Address - Street 1:811 EDMOND AVE
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6342
Practice Address - Country:US
Practice Address - Phone:850-363-4269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18612101YP2500X
GALPC013290101YP2500X
FLIMH17671101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional