MEDICARE: PROF. PATRICIA ANNE KENNINGTON PH.D.

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	LPC002371	GA
2	101YM0800X	Mental Health Counselor	LPC002371	GA
3	101YP2500X	Professional Counselor	LPC002371	GA

General Provider Information

NPI Number	:	1861410235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. PATRICIA ANNE KENNINGTON PH.D.

Provider Business Mailing Address
First Line	:	388 CHESTER ST SE
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-2086
Country	:	US
Telephone Number	:	770-425-3813
Fax Number	:	866-220-6012

Provider Business Practice Location Address
First Line	:	2470 WINDY HILL RD SE
Second Line	:	SUITE 319-B
City	:	MARIETTA
State	:	GA
Zip	:	30067-8613
Country	:	US
Telephone Number	:	678-773-1630
Fax Number	:

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	09/11/2025

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