Provider Demographics
NPI:1679772289
Name:KENNEDY, NATASHA C (LCSW, LISW-CP)
Entity Type:Individual
Prefix:MISS
First Name:NATASHA
Middle Name:C
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LCSW, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1162 TURKEY TROT DR
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-8798
Mailing Address - Country:US
Mailing Address - Phone:843-990-6302
Mailing Address - Fax:
Practice Address - Street 1:1715 HOLLYDALE CT UNIT B
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-8319
Practice Address - Country:US
Practice Address - Phone:843-268-4848
Practice Address - Fax:843-305-3776
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0059971041C0700X
GACSW0066361041C0700X
SC126681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical