MEDICARE: MRS. VANESSA MOCK KENT M.A.

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	101YM0800X	Mental Health Counselor	LMHC#1872	FL
2	106H00000X	Marriage & Family Therapist	LMFT#1129	NC
3	106H00000X	Marriage & Family Therapist	LMFT#1795	FL

General Provider Information

NPI Number	:	1285952481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VANESSA MOCK KENT M.A.

Provider Business Mailing Address
First Line	:	275 WATERVILLE ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27603-1989
Country	:	US
Telephone Number	:	919-772-8459
Fax Number	:	919-772-8459

Provider Business Practice Location Address
First Line	:	1215 JONES FRANKLIN RD
Second Line	:	SUITE 201
City	:	RALEIGH
State	:	NC
Zip	:	27606-3351
Country	:	US
Telephone Number	:	919-851-1527
Fax Number	:	919-851-3555

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

Provider Enumeration Date	:	05/12/2010
Last Update Date	:	05/12/2010

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