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General NPI Number Information
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NPI Number | 1275869653
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Entity Type | Individual
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Provider Name | CAROL ANN KENISON MA, LLP, LPC
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Gender | Female
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Dates
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Enumeration Date | 10/20/2009
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 130 N MAIN ST
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City | LAKE CITY
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State | MI
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Zip | 49651-5103
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Country | US
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Telephone | 231-295-1196
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Fax |
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Provider Business Mailing Address
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Address Line | 602 S WILSON AVE
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City | ROYAL OAK
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State | MI
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Zip | 48067-2950
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Country | US
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Telephone | 248-867-2499
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401008847
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301013036
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401008847
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License Number State | MI
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