Provider Demographics
NPI:1285868836
Name:KENNEDY, NINA MICHELLE (LMFT)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:MICHELLE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 E BOLTON ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-5920
Mailing Address - Country:US
Mailing Address - Phone:912-447-5530
Mailing Address - Fax:
Practice Address - Street 1:408 E BOLTON ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-5920
Practice Address - Country:US
Practice Address - Phone:912-447-5530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001080106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist