Provider Demographics
NPI:1730550427
Name:KENNEDY, CHARNEQUA AUSTIN (LPC-MHSP)
Entity type:Individual
Prefix:MS
First Name:CHARNEQUA
Middle Name:AUSTIN
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 MALLORY LANE SUITE 130-337
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8209
Mailing Address - Country:US
Mailing Address - Phone:615-434-4626
Mailing Address - Fax:
Practice Address - Street 1:2000 MALLORY LANE SUITE 130-337
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-8209
Practice Address - Country:US
Practice Address - Phone:615-434-4626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor