Provider Demographics
NPI:1225276058
Name:KENDRICK, JERELINE (PHD,MFT)
Entity Type:Individual
Prefix:DR
First Name:JERELINE
Middle Name:
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:PHD,MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4795 ANTELOPE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534
Mailing Address - Country:US
Mailing Address - Phone:707-688-3075
Mailing Address - Fax:
Practice Address - Street 1:4795 ANTELOPE CIR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-3940
Practice Address - Country:US
Practice Address - Phone:707-688-3075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-02
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201325106H00000X
CA20679106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist