Provider Demographics
NPI:1811120397
Name:DEPAUL, KENNETH EDWARD II (LCSW)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:EDWARD
Last Name:DEPAUL
Suffix:II
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3125 POPLARWOOD COURT
Mailing Address - Street 2:SUITE 150
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-6445
Mailing Address - Country:US
Mailing Address - Phone:919-872-7373
Mailing Address - Fax:919-872-3713
Practice Address - Street 1:3125 POPLARWOOD COURT
Practice Address - Street 2:SUITE 150
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-6445
Practice Address - Country:US
Practice Address - Phone:919-872-7373
Practice Address - Fax:919-872-3713
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0072881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical