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General NPI Number Information
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NPI Number | 1346621240
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Entity Type | Individual
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Provider Name | KENNETH ALCORN LCSW
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Gender | Male
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Dates
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Enumeration Date | 06/16/2015
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 965 S HIGHWAY 25 W
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City | WILLIAMSBURG
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State | KY
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Zip | 40769-1608
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Country | US
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Telephone | 606-549-2656
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 540
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City | JELLICO
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State | TN
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Zip | 37762-0540
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Country | US
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Telephone | 423-784-8492
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Fax | 423-784-8358
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 094954
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8508
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License Number State | TN
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