Organization
CAROLINA BEHAVIORAL MEDICINE, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD CAULEY KENNERLY PHD (OWNER)
(704) 659-3541
Entity
Organization
Contact information
Practice address
1036 BRANCHVIEW DR, SUITE 201, CONCORD, NC 28025-2998
(704) 659-3541
(888) 977-3202
Mailing address
366 GEORGE W LILES PKWY NW, STE 52, CONCORD, NC 28027-2406
(704) 659-3541
(704) 706-2348
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
4561
NC
Other
Enumeration date
12/06/2014
Last updated
04/24/2015
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