Provider Demographics
NPI:1639932361
Name:DOCK, KENYA YVONNE (MS)
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:YVONNE
Last Name:DOCK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:KENYA
Other - Middle Name:YVONNE
Other - Last Name:GARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2626 TEAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-6059
Mailing Address - Country:US
Mailing Address - Phone:706-294-2614
Mailing Address - Fax:
Practice Address - Street 1:2626 TEAKWOOD DR
Practice Address - Street 2:
Practice Address - City:HEPHZIBAH
Practice Address - State:GA
Practice Address - Zip Code:30815-6059
Practice Address - Country:US
Practice Address - Phone:706-294-2614
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
GALPC013111101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional