Provider Demographics
NPI:1164100913
Name:KENYEAR, TEDDI R (LPC)
Entity Type:Individual
Prefix:MS
First Name:TEDDI
Middle Name:R
Last Name:KENYEAR
Suffix:
Gender:F
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:PO BOX 319
Mailing Address - Street 2:
Mailing Address - City:TOPPING
Mailing Address - State:VA
Mailing Address - Zip Code:23169-0319
Mailing Address - Country:US
Mailing Address - Phone:804-517-1241
Mailing Address - Fax:
Practice Address - Street 1:12800 W CREEK PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-1116
Practice Address - Country:US
Practice Address - Phone:804-517-1241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701013150101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health