Provider Demographics
NPI:1114012770
Name:KENDALL, LINDA (LPC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:KENDALL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 CORBERRIE LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-4315
Mailing Address - Country:US
Mailing Address - Phone:919-696-6163
Mailing Address - Fax:919-861-8893
Practice Address - Street 1:2005 CORBERRIE LN
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-4315
Practice Address - Country:US
Practice Address - Phone:919-696-6163
Practice Address - Fax:919-861-8893
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3379101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC133HJOtherBLUE CROSS BLUE SJIELD
NY549478OtherVALUE OPTIONS
NC2928OtherMEDCOST
NC366022OtherMANAGEDHEALTHNETWORK MHN