Provider Demographics
NPI:1114187036
Name:SIDDEN, KEVIN RONALD (LPC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:RONALD
Last Name:SIDDEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 EASTCHESTER DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-3170
Mailing Address - Country:US
Mailing Address - Phone:336-906-7688
Mailing Address - Fax:
Practice Address - Street 1:1208 EASTCHESTER DR
Practice Address - Street 2:SUITE 240
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-3170
Practice Address - Country:US
Practice Address - Phone:336-906-7688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3713101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3713OtherNCBLPC