Provider Demographics
NPI:1215369061
Name:YAKOVLEFF, KENDRA ALICE (ADDICTION COUSELOR)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:ALICE
Last Name:YAKOVLEFF
Suffix:
Gender:F
Credentials:ADDICTION COUSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 ELM ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03603-5006
Mailing Address - Country:US
Mailing Address - Phone:603-826-3704
Mailing Address - Fax:
Practice Address - Street 1:254 PLAINFIELD RD
Practice Address - Street 2:
Practice Address - City:WEST LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03784-2001
Practice Address - Country:US
Practice Address - Phone:603-298-2146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-04
Last Update Date:2013-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH101YA0400X101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH101YA0400XMedicaid