Provider Demographics
NPI:1356836811
Name:KENNEL, AMY (LPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:KENNEL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8767 SEMINOLE TRL STE 101
Mailing Address - Street 2:
Mailing Address - City:RUCKERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22968-3494
Mailing Address - Country:US
Mailing Address - Phone:434-990-1744
Mailing Address - Fax:804-819-5221
Practice Address - Street 1:8767 SEMINOLE TRL STE 101
Practice Address - Street 2:
Practice Address - City:RUCKERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22968-3494
Practice Address - Country:US
Practice Address - Phone:434-990-1744
Practice Address - Fax:434-939-9401
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA07010007736101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health