Provider Demographics
NPI:1407329857
Name:PRYOR, KENNETH
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:PRYOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5206 MARKEL RD STE 301
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3044
Mailing Address - Country:US
Mailing Address - Phone:804-505-4737
Mailing Address - Fax:804-505-5179
Practice Address - Street 1:5206 MARKEL RD STE 301
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3044
Practice Address - Country:US
Practice Address - Phone:804-505-4737
Practice Address - Fax:804-505-5179
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health