Provider Demographics
NPI:1336248350
Name:FRAZIER, KENNETH A (LPC)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:A
Last Name:FRAZIER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5318 W FRIENDLY AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4349
Mailing Address - Country:US
Mailing Address - Phone:336-292-6947
Mailing Address - Fax:336-292-7409
Practice Address - Street 1:5318 W FRIENDLY AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4349
Practice Address - Country:US
Practice Address - Phone:336-292-6947
Practice Address - Fax:336-292-7409
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPC341101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC33713OtherIND BCBS
NC0195OtherV GROUP BCBS