Healthcare Provider Details

I. General information

NPI: 1790854420
Provider Name (Legal Business Name): MS. NAYNETTE KENNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 WOOTEN LAKE RD NW STE 210
KENNESAW GA
30144-1348
US

IV. Provider business mailing address

2774 COBB PKWY NW STE 109-140
KENNESAW GA
30152-3469
US

V. Phone/Fax

Practice location:
  • Phone: 404-447-9241
  • Fax:
Mailing address:
  • Phone: 404-447-9241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5506
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5583
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: