Kennard Nears, M.S., LPC, NCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

005130 Issued in GA

Practice address

187 Shenandoah Dr
Riverdale, GA 30274-3247

Phone

(919) 395-3622

NPI assigned

Jan 14, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1168732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554076800000",
    "number": "1881745263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "187 SHENANDOAH DR",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302743247",
            "telephone_number": "919-395-6222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "187 SHENANDOAH DR",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302743247",
            "telephone_number": "919-395-3622"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2911 Ligon St Apt A11",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276075561",
            "country_code": "US",
            "telephone_number": "919-395-3622",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NEARS",
        "first_name": "KENNARD",
        "name_prefix": "Dr.",
        "credential": "M.S., LPC, NCC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-14",
        "last_updated": "2019-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NC",
            "license": "5129",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "005130",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "526553690B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6103009",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Riverdale, GA
• Providers in Riverdale, GA by specialty
• Mental Health Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2019; 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.