Individual
KENNY HOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
615 SHIPYARD BLVD, WILMINGTON, NC 28412-6431
(910) 343-0145
Mailing address
615 SHIPYARD BLVD, WILMINGTON, NC 28412-6431
(910) 343-0145
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
6110508
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6110508
—
NC
Enumeration date
03/09/2007
Last updated
07/08/2007
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