Provider Demographics
NPI:1134504475
Name:LILLEY, KENDRA
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:LILLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:ANN
Other - Last Name:HAMMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 ALEXANDER RD
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-8405
Mailing Address - Country:US
Mailing Address - Phone:828-243-5492
Mailing Address - Fax:
Practice Address - Street 1:1100 RIDGEFIELD BLVD
Practice Address - Street 2:#190
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-6209
Practice Address - Country:US
Practice Address - Phone:828-670-7723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11261101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health