Provider Demographics
NPI:1093229643
Name:WITHERSPOON, KENDRA (LPC)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:WITHERSPOON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, NCC
Mailing Address - Street 1:PO BOX 18382
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-0382
Mailing Address - Country:US
Mailing Address - Phone:404-482-0009
Mailing Address - Fax:
Practice Address - Street 1:730 PEACHTREE ST NE STE 570
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308
Practice Address - Country:US
Practice Address - Phone:404-482-0009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-18
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008797101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional