Provider Demographics
NPI:1326680877
Name:KENNEDY COUNSELING GROUP
Entity Type:Organization
Organization Name:KENNEDY COUNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:ZENOVIA
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:757-270-9449
Mailing Address - Street 1:100 7TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-4800
Mailing Address - Country:US
Mailing Address - Phone:757-270-9449
Mailing Address - Fax:757-257-6800
Practice Address - Street 1:100 7TH ST STE 104
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-4800
Practice Address - Country:US
Practice Address - Phone:757-270-9449
Practice Address - Fax:757-257-6800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty