Provider Demographics
NPI:1881745263
Name:NEARS, KENNARD (MS, LPC, NCC)
Entity type:Individual
Prefix:DR
First Name:KENNARD
Middle Name:
Last Name:NEARS
Suffix:
Gender:M
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 SHENANDOAH DR
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-3247
Mailing Address - Country:US
Mailing Address - Phone:919-395-6222
Mailing Address - Fax:
Practice Address - Street 1:187 SHENANDOAH DR
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-3247
Practice Address - Country:US
Practice Address - Phone:919-395-3622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5129101Y00000X
GA005130101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA526553690BMedicaid
NC6103009Medicaid