Provider Demographics
NPI:1609215045
Name:PATAKY, KENNETH R (MS, LCMHC, LMHC)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:R
Last Name:PATAKY
Suffix:
Gender:M
Credentials:MS, LCMHC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4058 COBBLER CT
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-7788
Mailing Address - Country:US
Mailing Address - Phone:336-454-0426
Mailing Address - Fax:336-450-2644
Practice Address - Street 1:4058 COBBLER CT
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NC
Practice Address - Zip Code:27282-7788
Practice Address - Country:US
Practice Address - Phone:336-454-0426
Practice Address - Fax:336-450-2644
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10249101YP2500X, 101YM0800X
HIMHC-662101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional