=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205046232
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENSHIA JEANELL DUNCAN LGSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 PERRY HILL RD
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36109-3725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-272-4670
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5001 PADDOCK CLUB CT APARTMENT F
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36116-4318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-221-4133
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 2024G
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------