Provider Demographics
NPI:1831469022
Name:KENNEDY, VENUS ELIZABETH (LCMHC)
Entity Type:Individual
Prefix:
First Name:VENUS
Middle Name:ELIZABETH
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:VENUS
Other - Middle Name:
Other - Last Name:JACOBUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:322 LAMAR AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2436
Mailing Address - Country:US
Mailing Address - Phone:704-313-3088
Mailing Address - Fax:704-313-3088
Practice Address - Street 1:322 LAMAR AVE STE 204
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2436
Practice Address - Country:US
Practice Address - Phone:704-313-3088
Practice Address - Fax:704-313-3088
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-13705101YM0800X
NC12560101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health