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General NPI Number Information
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NPI Number | 1881745263
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Entity Type | Individual
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Provider Name | KENNARD NEARS M.S., LPC, NCC
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Gender | Male
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Dates
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Enumeration Date | 01/14/2007
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Last Update Date | 04/01/2019
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Provider Practice Location Address
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Address Line | 187 SHENANDOAH DR
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City | RIVERDALE
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State | GA
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Zip | 30274-3247
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Country | US
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Telephone | 919-395-3622
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Fax |
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Provider Business Mailing Address
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Address Line | 187 SHENANDOAH DR
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City | RIVERDALE
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State | GA
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Zip | 30274-3247
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Country | US
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Telephone | 919-395-6222
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 5129
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 005130
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License Number State | GA
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