Provider Demographics
NPI:1033187521
Name:KITTRELL, BRENDA L (LMSW, ACSW, MAC)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:L
Last Name:KITTRELL
Suffix:
Gender:F
Credentials:LMSW, ACSW, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 LANYARD DR NE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-1333
Mailing Address - Country:US
Mailing Address - Phone:253-226-2225
Mailing Address - Fax:
Practice Address - Street 1:3808 LANYARD DR NE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-1333
Practice Address - Country:US
Practice Address - Phone:253-226-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN24843101YA0400X
MI68010810801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)