Provider Demographics
NPI:1629579677
Name:KENNEDY COUNSELING COLLECTIVE LLC
Entity Type:Organization
Organization Name:KENNEDY COUNSELING COLLECTIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERWERFF
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:202-630-0496
Mailing Address - Street 1:508 KENNEDY ST NW STE 300
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-3010
Mailing Address - Country:US
Mailing Address - Phone:202-630-0496
Mailing Address - Fax:
Practice Address - Street 1:508 KENNEDY ST NW STE 300
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-3010
Practice Address - Country:US
Practice Address - Phone:202-630-0496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty