Individual
KENNETH WAYNE FAVORS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCDADC
Contact information
Practice address
8 BROMPTON COURT, ELKTON, MD 21921
(410) 398-7104
Mailing address
8 BROMPTON COURT, ELKTON, MD 21921
(240) 353-0279
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCA1943
MD
101YM0800X
Mental Health Counselor
LCA1943
MD
101YP2500X
Professional Counselor
Primary
LCA1943
MD
Other
Enumeration date
11/18/2016
Last updated
11/18/2016
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