Provider Demographics
NPI:1215412770
Name:KENNEDY, LAWANA D (LIC PROF COUNSELOR)
Entity Type:Individual
Prefix:MS
First Name:LAWANA
Middle Name:D
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LIC PROF COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 BEL AIR BLVD STE 304
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-3507
Mailing Address - Country:US
Mailing Address - Phone:251-680-4217
Mailing Address - Fax:
Practice Address - Street 1:316 BEL AIR BLVD STE 304
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-3507
Practice Address - Country:US
Practice Address - Phone:251-680-4217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3569101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional