Provider Demographics
NPI:1417152513
Name:KESSEL, KENNNETH A (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KENNNETH
Middle Name:A
Last Name:KESSEL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 HORTON ST
Mailing Address - Street 2:APT 202
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-3424
Mailing Address - Country:US
Mailing Address - Phone:646-286-8015
Mailing Address - Fax:919-856-5772
Practice Address - Street 1:568 E LENOIR ST
Practice Address - Street 2:STE 204
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-2408
Practice Address - Country:US
Practice Address - Phone:919-856-5385
Practice Address - Fax:919-856-5772
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0052381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106343Medicaid