Individual
KENYAH MONET MICKENS-SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMFT, LCAS
Contact information
Practice address
1300 BAXTER ST STE 421, CHARLOTTE, NC 28204-3026
(704) 995-0342
(704) 943-0707
Mailing address
7745 BALLANTYNE COMMONS PKWY STE 102, CHARLOTTE, NC 28277-5056
(704) 995-0342
(704) 943-0707
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
106H00000X
Marriage & Family Therapist
Primary
2490
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2490
LMFT
NC
Enumeration date
09/25/2020
Last updated
07/06/2023
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