=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952516189
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COLLEEN M. KENNY LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2007
-----------------------------------------------------
Last Update Date | 08/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 112A PASTURE LN
-----------------------------------------------------
City | CAPE CARTERET
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28584-0198
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-673-5282
-----------------------------------------------------
Fax | 855-229-1716
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4111
-----------------------------------------------------
City | EMERALD ISLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28594-4111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-673-5282
-----------------------------------------------------
Fax | 855-229-1716
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 1697
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------