Provider Demographics
NPI:1932719168
Name:KENT, STEVEN WILBURN (BSW, CSAC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:WILBURN
Last Name:KENT
Suffix:
Gender:M
Credentials:BSW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12120 WIESINGER LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2248
Mailing Address - Country:US
Mailing Address - Phone:804-502-2785
Mailing Address - Fax:
Practice Address - Street 1:10049 MIDLOTHIAN TPKE STE B2
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4859
Practice Address - Country:US
Practice Address - Phone:804-320-8032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA071010343476101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)