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General NPI Number Information
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NPI Number | 1487260204
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Entity Type | Individual
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Provider Name | KENNETH RICHARD BOND II LCPC
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Gender | Male
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Dates
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Enumeration Date | 09/17/2020
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Last Update Date | 09/17/2020
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Provider Practice Location Address
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Address Line | 6079 ERINBLAIR LOOP
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City | HAYMARKET
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State | VA
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Zip | 20169-2613
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Country | US
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Telephone | 240-324-7319
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 970
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City | HAYMARKET
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State | VA
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Zip | 20168-0970
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Country | US
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Telephone | 703-655-1701
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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 | LC10795
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License Number State | MD
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