Provider Demographics
NPI:1164461216
Name:KENDRICKS, DAPHNE (PHD)
Entity Type:Individual
Prefix:
First Name:DAPHNE
Middle Name:
Last Name:KENDRICKS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 N COLLEGE RD # C-124
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-8826
Mailing Address - Country:US
Mailing Address - Phone:619-323-9459
Mailing Address - Fax:
Practice Address - Street 1:3224 N COLLEGE RD # C-124
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-8826
Practice Address - Country:US
Practice Address - Phone:619-323-9459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-TL-0400103TC0700X
NC2734103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP01194345OtherRR MEDICARE
NC6000187Medicaid
NCP01194345OtherRR MEDICARE
NC7697321OtherAETNA
NC045N6OtherBCBSNC
NC7697321OtherAETNA
NC6000187Medicaid