Healthcare Provider Details

I. General information

NPI: 1952516189
Provider Name (Legal Business Name): COLLEEN M. KENNY LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112A PASTURE LN
CAPE CARTERET NC
28584-0198
US

IV. Provider business mailing address

PO BOX 4111
EMERALD ISLE NC
28594-4111
US

V. Phone/Fax

Practice location:
  • Phone: 919-673-5282
  • Fax: 855-229-1716
Mailing address:
  • Phone: 919-673-5282
  • Fax: 855-229-1716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1697
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: