Provider Demographics
NPI:1891197802
Name:KENNEDY, MEGAN (EDS, MED, NCC)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:EDS, MED, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 CHURCH ST N
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-4589
Mailing Address - Country:US
Mailing Address - Phone:704-262-1360
Mailing Address - Fax:
Practice Address - Street 1:363 CHURCH ST N
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4589
Practice Address - Country:US
Practice Address - Phone:704-262-1360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health