Provider Demographics
NPI:1952516189
Name:KENNY, COLLEEN M (LMFT)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:KENNY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4111
Mailing Address - Street 2:
Mailing Address - City:EMERALD ISLE
Mailing Address - State:NC
Mailing Address - Zip Code:28594-4111
Mailing Address - Country:US
Mailing Address - Phone:919-673-5282
Mailing Address - Fax:855-229-1716
Practice Address - Street 1:3025 HIGHWAY 24 UNIT 3
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570-5084
Practice Address - Country:US
Practice Address - Phone:919-673-5282
Practice Address - Fax:855-229-1716
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1697106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist