Provider Demographics
NPI:1215346283
Name:KERN, CONNIE (NCC, LCMHC, NBCR)
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:
Last Name:KERN
Suffix:
Gender:F
Credentials:NCC, LCMHC, NBCR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 ELM ST STE 200
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-4164
Mailing Address - Country:US
Mailing Address - Phone:646-588-8176
Mailing Address - Fax:
Practice Address - Street 1:823 ELM ST STE 200
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4164
Practice Address - Country:US
Practice Address - Phone:646-588-8176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
B01659173C00000X
NC19224101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No173C00000XOther Service ProvidersReflexologist