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Individual

MR. KENNETH EARL RUDOLPH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1600 LAKESIDE DR, LYNCHBURG, VA 24501-3116
(434) 363-7219
Mailing address
1600 LAKESIDE DR, LYNCHBURG, VA 24501-3116
(434) 363-7219

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
62252
TX
1041C0700X
Clinical Social Worker
0904018643
VA
1041C0700X
Clinical Social Worker
Primary
62252
TX

Other

Enumeration date
07/11/2018
Last updated
03/16/2026
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