Provider Demographics
NPI:1487832127
Name:KENYON, SUSAN ELIZABETH (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:KENYON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 OSBORNE RD STE F
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-9103
Mailing Address - Country:US
Mailing Address - Phone:912-510-9227
Mailing Address - Fax:912-510-9228
Practice Address - Street 1:1712 OSBORNE RD STE F
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-9103
Practice Address - Country:US
Practice Address - Phone:912-510-9227
Practice Address - Fax:912-510-9228
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0038271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical