Provider Demographics
NPI:1275959421
Name:KENNEDY, WILLIAM (LPC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:KENNEDY
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 1:3633 WHEELER RD
Mailing Address - Street 2:SUITE 365
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6549
Mailing Address - Country:US
Mailing Address - Phone:706-825-9300
Mailing Address - Fax:706-432-8775
Practice Address - Street 1:3633 WHEELER RD
Practice Address - Street 2:SUITE 365
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6549
Practice Address - Country:US
Practice Address - Phone:706-825-9300
Practice Address - Fax:706-432-8775
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACAADC101YA0400X
GALPC007699101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)