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General NPI Number Information
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NPI Number | 1649571183
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Entity Type | Individual
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Provider Name | LISA A KENNEDY LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/16/2010
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Last Update Date | 07/19/2022
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Provider Practice Location Address
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Address Line | 1090 ARNOLD DR
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City | LITTLE ROCK AFB
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State | AR
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Zip | 72099-4933
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Country | US
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Telephone | 501-987-7377
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Fax | 501-987-8852
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Provider Business Mailing Address
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Address Line | 1090 ARNOLD DR
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City | LITTLE ROCK AFB
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State | AR
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Zip | 72099-4933
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Country | US
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Telephone | 501-987-7377
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Fax | 501-987-8852
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2461-C
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 2461-C
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2461-C
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License Number State | AR
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