Provider Demographics
NPI:1417095670
Name:KENYON, RAYMOMD WILLIAM (LPC, NCC, DCC, CSMS)
Entity Type:Individual
Prefix:PROF
First Name:RAYMOMD
Middle Name:WILLIAM
Last Name:KENYON
Suffix:
Gender:M
Credentials:LPC, NCC, DCC, CSMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 464
Mailing Address - Street 2:
Mailing Address - City:LINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28646-0464
Mailing Address - Country:US
Mailing Address - Phone:828-260-4248
Mailing Address - Fax:
Practice Address - Street 1:180 LONGVIEW RD.
Practice Address - Street 2:
Practice Address - City:NEWLAND
Practice Address - State:NC
Practice Address - Zip Code:28657
Practice Address - Country:US
Practice Address - Phone:828-260-4248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4015101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional