Healthcare Provider Details

I. General information

NPI: 1003038258
Provider Name (Legal Business Name): KENNETH LLOYD JR. LICDC, LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 HIGH ST NE
WARREN OH
44481-1222
US

IV. Provider business mailing address

320 HIGH ST NE
WARREN OH
44481-1222
US

V. Phone/Fax

Practice location:
  • Phone: 330-394-9090
  • Fax: 330-394-8163
Mailing address:
  • Phone: 330-394-9090
  • Fax: 330-394-8163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number841092
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS,0016334
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: