Provider Demographics
NPI:1922597459
Name:KENNEDY-ZIEGLER, DEBORAH VICTORIA (PHD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:VICTORIA
Last Name:KENNEDY-ZIEGLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:15720 BRIXHAM HILL AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-4785
Mailing Address - Country:US
Mailing Address - Phone:704-970-4791
Mailing Address - Fax:704-970-4794
Practice Address - Street 1:15720 BRIXHAM HILL AVE STE 150
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4785
Practice Address - Country:US
Practice Address - Phone:704-970-4791
Practice Address - Fax:704-970-4794
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5298103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical