Individual
ROBERT KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
313 W VALENCIA ST, LAKELAND, FL 33805-3138
(863) 632-4725
Mailing address
313 W VALENCIA ST, LAKELAND, FL 33805-3138
(863) 632-4725
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
198
FL
101YP2500X
Professional Counselor
5758
FL
171W00000X
Contractor
449
FL
Other
Enumeration date
08/20/2016
Last updated
08/20/2016
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