=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013628460
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAWN KENNEDY MA, LPA, HSP-PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/07/2022
-----------------------------------------------------
Last Update Date | 10/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1004 WERRINGTON DR STE 200
-----------------------------------------------------
City | HOLLY SPRINGS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27540-6018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-552-9952
-----------------------------------------------------
Fax | 919-552-3062
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4705 UNIVERSITY DR BLDG 700
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27707-3489
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-237-1337
-----------------------------------------------------
Fax | 866-538-4716
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 6242
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------