MEDICARE: MS. CHARNEQUA AUSTIN KENNEDY LPC-MHSP

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1730550427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHARNEQUA AUSTIN KENNEDY LPC-MHSP

Provider Business Mailing Address
First Line	:	2000 MALLORY LANE SUITE 130-337
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-8209
Country	:	US
Telephone Number	:	615-434-4626
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 MALLORY LANE SUITE 130-337
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-8209
Country	:	US
Telephone Number	:	615-434-4626
Fax Number	:

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

Provider Enumeration Date	:	10/07/2015
Last Update Date	:	04/22/2021

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Directions to “ MS. CHARNEQUA AUSTIN KENNEDY LPC-MHSP” Practice Location

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