MEDICARE: STEVEN WILBURN KENT BSW, CSAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	071010343476	VA

General Provider Information

NPI Number	:	1932719168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN WILBURN KENT BSW, CSAC

Provider Business Mailing Address
First Line	:	12120 WIESINGER LN
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23113-2248
Country	:	US
Telephone Number	:	804-502-2785
Fax Number	:

Provider Business Practice Location Address
First Line	:	10049 MIDLOTHIAN TPKE STE B2
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-4859
Country	:	US
Telephone Number	:	804-320-8032
Fax Number	:

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

Provider Enumeration Date	:	08/03/2020
Last Update Date	:	08/03/2020

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