Provider Demographics
NPI:1669690186
Name:DENNY, KEVIN RAYMOND (MS, LCAS)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:RAYMOND
Last Name:DENNY
Suffix:
Gender:M
Credentials:MS, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 EASTSIDE DR
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-5445
Mailing Address - Country:US
Mailing Address - Phone:704-838-1497
Mailing Address - Fax:
Practice Address - Street 1:119 W WATER ST STE C
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-5282
Practice Address - Country:US
Practice Address - Phone:704-763-0851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)