MEDICARE: DR. KENNEITH DURDEN LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC005202	GA

General Provider Information

NPI Number	:	1184895930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNEITH DURDEN LPC

Provider Business Mailing Address
First Line	:	7306 GA HIGHWAY 21
Second Line	:	STE 101-225
City	:	PORT WENTWORTH
State	:	GA
Zip	:	31407-9274
Country	:	US
Telephone Number	:	404-909-2442
Fax Number	:

Provider Business Practice Location Address
First Line	:	7306 GA HIGHWAY 21
Second Line	:	STE 101-225
City	:	PORT WENTWORTH
State	:	GA
Zip	:	31407-9274
Country	:	US
Telephone Number	:	404-909-2442
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2008
Last Update Date	:	07/14/2016

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