Healthcare Provider Details

I. General information

NPI: 1124493309
Provider Name (Legal Business Name): SONYA KENNEDY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2015
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 DUNWOODY PARK SUITE 136
ATLANTA GA
30338-7407
US

IV. Provider business mailing address

9 DUNWOODY PARK SUITE 136
ATLANTA GA
30338-7407
US

V. Phone/Fax

Practice location:
  • Phone: 770-744-5055
  • Fax: 470-545-4382
Mailing address:
  • Phone: 770-744-5055
  • Fax: 470-545-4382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC005673
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: