Provider Demographics
NPI:1699502039
Name:PATRICK, KENT (LPC)
Entity type:Individual
Prefix:
First Name:KENT
Middle Name:
Last Name:PATRICK
Suffix:
Gender:F
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:PO BOX 590
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:WV
Mailing Address - Zip Code:24983-0590
Mailing Address - Country:US
Mailing Address - Phone:304-956-0004
Mailing Address - Fax:
Practice Address - Street 1:142 JAMES MONROE DR
Practice Address - Street 2:
Practice Address - City:LINDSIDE
Practice Address - State:WV
Practice Address - Zip Code:24951-7168
Practice Address - Country:US
Practice Address - Phone:304-772-3064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3023101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health