Provider Demographics
NPI:1568225357
Name:KERR, NATHAN (PHD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:KERR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6033 LANDS END LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-2669
Mailing Address - Country:US
Mailing Address - Phone:850-766-5751
Mailing Address - Fax:
Practice Address - Street 1:6033 LANDS END LN
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-2669
Practice Address - Country:US
Practice Address - Phone:850-766-5751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06415103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling