Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 106E00000X | Assistant Behavior Analyst |
NPI | 1154976546 |
---|---|
Provider Name | Carmen Kennedy |
First Address | Indianapolis, IN 46218-5046 |
Second Address | Indianapolis, IN 46218-3109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2019 |
Last Update Date | 02/08/2019 |