Provider Demographics
NPI:1225577968
Name:KENYON, KARI (AOD COUNSELOR)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:
Last Name:KENYON
Suffix:
Gender:F
Credentials:AOD COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 WRIGHT ST APT 8
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-3437
Mailing Address - Country:US
Mailing Address - Phone:360-461-1190
Mailing Address - Fax:
Practice Address - Street 1:1380 WRIGHT ST APT 8
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-3437
Practice Address - Country:US
Practice Address - Phone:360-461-1190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-14
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10894101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)