Provider Demographics
NPI:1104022177
Name:KENNINGTON, TOSHANIKA M (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:TOSHANIKA
Middle Name:M
Last Name:KENNINGTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 333 BOX 7791
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96251-0078
Mailing Address - Country:US
Mailing Address - Phone:910-359-6299
Mailing Address - Fax:
Practice Address - Street 1:549TH HOSPITAL CENTER UNIT #15245
Practice Address - Street 2:FAMILY ADVOCACY PROGRAM - BH
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96251-0078
Practice Address - Country:US
Practice Address - Phone:315-737-5671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0063931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC211678-PMedicaid