Organization
DR KENNEITH DURDEN OUTREACH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNEITH DURDEN (CEO)
(404) 909-2442
Entity
Organization
Contact information
Practice address
41 MOONLIGHT TRL, PORT WENTWORTH, GA 31407-3321
(404) 909-2442
Mailing address
41 MOONLIGHT TRL, PORT WENTWORTH, GA 31407-3321
(404) 909-2442
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
803411511B
—
GA
Enumeration date
04/29/2016
Last updated
04/29/2016
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