Healthcare Provider Details

I. General information

NPI: 1215346283
Provider Name (Legal Business Name): CONNIE KERN NCC, LCMHC, NBCR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 ELM ST STE 200
FAYETTEVILLE NC
28303-4164
US

IV. Provider business mailing address

823 ELM ST STE 200
FAYETTEVILLE NC
28303-4164
US

V. Phone/Fax

Practice location:
  • Phone: 646-588-8176
  • Fax:
Mailing address:
  • Phone: 646-588-8176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberB01659
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number19224
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: