Provider Demographics
NPI:1104526144
Name:KENYAS COUNSELING AND CONSULTING
Entity type:Organization
Organization Name:KENYAS COUNSELING AND CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:REVON
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, LMHC, CRC,
Authorized Official - Phone:229-220-5306
Mailing Address - Street 1:281 HARRELL MILL RD
Mailing Address - Street 2:
Mailing Address - City:CLIMAX
Mailing Address - State:GA
Mailing Address - Zip Code:39834-2778
Mailing Address - Country:US
Mailing Address - Phone:229-220-5306
Mailing Address - Fax:
Practice Address - Street 1:281 HARRELL MILL RD
Practice Address - Street 2:
Practice Address - City:CLIMAX
Practice Address - State:GA
Practice Address - Zip Code:39834-2778
Practice Address - Country:US
Practice Address - Phone:229-220-5306
Practice Address - Fax:888-493-0450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty