Provider Demographics
NPI:1588425839
Name:FOERMAN, KENNETH DUANE
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:DUANE
Last Name:FOERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 FAIRVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5324
Mailing Address - Country:US
Mailing Address - Phone:252-412-2445
Mailing Address - Fax:
Practice Address - Street 1:1905 FAIRVIEW WAY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5324
Practice Address - Country:US
Practice Address - Phone:252-412-2445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-28867101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)