Healthcare Provider Details

I. General information

NPI: 1982431136
Provider Name (Legal Business Name): JASON CORY KENT LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 ROPER MOUNTAIN RD STE 901
GREENVILLE SC
29615-4254
US

IV. Provider business mailing address

429 ROPER MOUNTAIN RD STE 901
GREENVILLE SC
29615-4254
US

V. Phone/Fax

Practice location:
  • Phone: 773-339-2714
  • Fax:
Mailing address:
  • Phone: 773-339-2714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701013939
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: