Provider Demographics
NPI:1497576854
Name:KENNESON, ALYSON COTTER (LMSW)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:COTTER
Last Name:KENNESON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ALYSON
Other - Middle Name:LYNDON
Other - Last Name:COTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA ED
Mailing Address - Street 1:303 SHANNON DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-1814
Mailing Address - Country:US
Mailing Address - Phone:407-304-0057
Mailing Address - Fax:
Practice Address - Street 1:41 PARK CREEK DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4270
Practice Address - Country:US
Practice Address - Phone:864-299-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC171371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical