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General NPI Number Information
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NPI Number | 1558962084
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Entity Type | Individual
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Provider Name | LATRESE D. KINNEY LMFT-A
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Gender | Female
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Dates
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Enumeration Date | 11/02/2020
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Last Update Date | 06/28/2021
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Provider Practice Location Address
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Address Line | 208 WEXFORD DR
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City | TAYLORS
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State | SC
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Zip | 29687-4232
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Country | US
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Telephone | 312-208-4956
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Fax |
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Provider Business Mailing Address
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Address Line | 3575 RUTHERFORD ROAD EXT STE B
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City | TAYLORS
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State | SC
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Zip | 29687-2168
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Country | US
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Telephone | 642-438-0988
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT7541
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License Number State | SC
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