Provider Demographics
NPI:1568140622
Name:KEMP, REGINALD BENJAMIN
Entity Type:Individual
Prefix:
First Name:REGINALD
Middle Name:BENJAMIN
Last Name:KEMP
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 1:301 S COLLEGE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-6043
Mailing Address - Country:US
Mailing Address - Phone:216-323-0033
Mailing Address - Fax:
Practice Address - Street 1:1000 BAXTER ST APT 613
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2843
Practice Address - Country:US
Practice Address - Phone:216-323-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker