Individual
MARTHA M. KENNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
119 BOONE RIDGE DR, SUITE 201, JOHNSON CITY, TN 37615-4998
(423) 282-1480
Mailing address
119 BOONE RIDGE DR, SUITE 201, JOHNSON CITY, TN 37615-4998
(423) 282-1480
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
293
AL
Other
Enumeration date
09/02/2006
Last updated
05/09/2016
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