Provider Demographics
NPI:1225852957
Name:KENNEDY, JORDAN (LPC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 BRAEBURN DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-7302
Mailing Address - Country:US
Mailing Address - Phone:540-529-8543
Mailing Address - Fax:540-378-6044
Practice Address - Street 1:1932 BRAEBURN DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7302
Practice Address - Country:US
Practice Address - Phone:540-529-8543
Practice Address - Fax:540-378-6044
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701014039101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional