Provider Demographics
NPI:1336919836
Name:KENNEY- MOYER, CEDRICE CHANEL
Entity Type:Individual
Prefix:
First Name:CEDRICE
Middle Name:CHANEL
Last Name:KENNEY- MOYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CEDRICE
Other - Middle Name:
Other - Last Name:KENNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:380 PINEWAY DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25405-5569
Mailing Address - Country:US
Mailing Address - Phone:304-433-6989
Mailing Address - Fax:
Practice Address - Street 1:380 PINEWAY DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25405-5569
Practice Address - Country:US
Practice Address - Phone:304-433-6989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health