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Contact Information

KENWANA M VANDERBILT, PSY.D.
MACON OUTPATIENT CLINIC- 5398 THOMASTON RD.
SUITE B
MACON, GA31220
 Phone: 478-476-8868
 Fax: 478-476-8161
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

103TC0700X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for KENWANA M VANDERBILT · (Female)

NPI # 1174864979
Status Active
Credentials PSY.D. (Doctor of Psychology)
Entity Individual
Enumeration date 03/05/2013
Last updated 03/09/2016 - About 10 years ago
Sole proprietor 1 No
Identifiers
  • GA License # PSY003494
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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