Provider Demographics
NPI:1497870190
Name:KENNEDY, LEEANN WILCOX (LPC)
Entity type:Individual
Prefix:MRS
First Name:LEEANN
Middle Name:WILCOX
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1442 MILITARY CUTOFF RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-3605
Mailing Address - Country:US
Mailing Address - Phone:910-270-9995
Mailing Address - Fax:
Practice Address - Street 1:1442 MILITARY CUTOFF RD UNIT B
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-3605
Practice Address - Country:US
Practice Address - Phone:910-270-9995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPC-3678101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC137W4OtherBCBS
NC6102645Medicaid