Kenique D Penn, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

004674 Issued in GA

Practice address

5755 N Point Pkwy
Suite 256
Alpharetta, GA 30022-1142

Phone

(770) 667-3877

Fax

(770) 667-3879

NPI assigned

Nov 27, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northside Psychological Services, Inc.

  • Clinical Psychologist
  • Marietta, GA
  • NPI 1184997439
  NPD (past)
• Northside Psychological Services, Inc.

  • Mental Health Counselor
  • Alpharetta, GA
  • NPI 1568527505

  Professional

  NPD (past)
• Outpatient Behavioral Health, LLC

  dba Northside Psychological Services

  • Mental Health Counselor
  • Alpharetta, GA
  • NPI 1700498979

  Professional

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222128000000",
    "number": "1679649206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 250",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300090250",
            "telephone_number": "770-316-5435",
            "fax_number": "770-667-3879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5755 N POINT PKWY",
            "address_2": "SUITE 256",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300221142",
            "telephone_number": "770-667-3877",
            "fax_number": "770-667-3879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENN",
        "first_name": "KENIQUE",
        "middle_name": "D",
        "name_prefix": "Miss",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-27",
        "last_updated": "2008-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "004674",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "673603439A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David M Pehrson, D.M.D.
• Ariella Peist, LCSW
• Kelsey Alexa Pelletier, PT, DPT
• Raine William Pendarvis, M.D.
• Raina Penkar
• Ashley Penney, FNP-BC
• Amanda Lin Pennington
• Larue D Penny Jr., M.D.
• Pentus Health Primary Care Alpharetta LLC
• Pentus Health Woundcare of Georgia

• Professional Counselor in Alpharetta, GA
• Providers in Alpharetta, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.