Provider Demographics
NPI:1922615962
Name:DRUMGOLD, KENNARD
Entity Type:Individual
Prefix:
First Name:KENNARD
Middle Name:
Last Name:DRUMGOLD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 N PARHAM RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4421
Mailing Address - Country:US
Mailing Address - Phone:804-918-2542
Mailing Address - Fax:
Practice Address - Street 1:3108 N PARHAM RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-4421
Practice Address - Country:US
Practice Address - Phone:804-918-2542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health