Provider Demographics
NPI:1700107430
Name:KENNEDY, TOQUI VERONIQUE (MA, LPA)
Entity Type:Individual
Prefix:
First Name:TOQUI
Middle Name:VERONIQUE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MA, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MARVISTA CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-9195
Mailing Address - Country:US
Mailing Address - Phone:919-271-2031
Mailing Address - Fax:
Practice Address - Street 1:4904 WATERS EDGE DR
Practice Address - Street 2:SUITE 151
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-2484
Practice Address - Country:US
Practice Address - Phone:919-271-2031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1976103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist