Provider Demographics
NPI:1952531527
Name:HISCOCK, KEVIN JOSEPH (RPA/RRA)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:JOSEPH
Last Name:HISCOCK
Suffix:
Gender:
Credentials:RPA/RRA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5023 GUENDALOSE CT
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-9467
Mailing Address - Country:US
Mailing Address - Phone:315-617-2982
Mailing Address - Fax:
Practice Address - Street 1:5023 GUENDALOSE CT
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-9467
Practice Address - Country:US
Practice Address - Phone:854-854-1774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
19649101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral