Provider Demographics
NPI:1649903204
Name:PENNINGTON, KACI ANN (NCC)
Entity type:Individual
Prefix:MRS
First Name:KACI
Middle Name:ANN
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4915 PRESTWICK LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-2253
Mailing Address - Country:US
Mailing Address - Phone:812-345-3973
Mailing Address - Fax:
Practice Address - Street 1:6302 FAIRVIEW RD STE 310
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3273
Practice Address - Country:US
Practice Address - Phone:765-343-6166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program