Provider Demographics
NPI:1346966843
Name:KERMEEN, TAVON AMBER
Entity Type:Individual
Prefix:
First Name:TAVON
Middle Name:AMBER
Last Name:KERMEEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 WESTERN BLVD STE Q
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6852
Mailing Address - Country:US
Mailing Address - Phone:910-858-5848
Mailing Address - Fax:704-785-8304
Practice Address - Street 1:445 WESTERN BLVD STE Q
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6852
Practice Address - Country:US
Practice Address - Phone:108-858-5848
Practice Address - Fax:047-858-3047
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NCA18773101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor