Provider Demographics
NPI:1477725968
Name:FAULKENBERRY, KEVIN LEMUEL (LMSW)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:LEMUEL
Last Name:FAULKENBERRY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 EBENEZER RD
Mailing Address - Street 2:SUITE J-2
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1062
Mailing Address - Country:US
Mailing Address - Phone:803-366-2525
Mailing Address - Fax:803-366-2527
Practice Address - Street 1:2025 EBENEZER RD
Practice Address - Street 2:SUITE J-2
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1062
Practice Address - Country:US
Practice Address - Phone:803-366-2525
Practice Address - Fax:803-366-2527
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8647101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health