Provider Demographics
NPI:1194050336
Name:SMITH, KENNETH PERRY (LPC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:PERRY
Last Name:SMITH
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 1:44 MOUNT VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-1119
Mailing Address - Country:US
Mailing Address - Phone:864-546-8027
Mailing Address - Fax:864-355-9752
Practice Address - Street 1:44 MOUNT VISTA AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-1119
Practice Address - Country:US
Practice Address - Phone:864-546-8027
Practice Address - Fax:864-355-9752
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5086101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional