Provider Demographics
NPI:1235363037
Name:PUGH, KENDRA LYNN (PSY D)
Entity Type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:LYNN
Last Name:PUGH
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-0579
Mailing Address - Country:US
Mailing Address - Phone:804-520-1655
Mailing Address - Fax:804-520-8595
Practice Address - Street 1:107 W ELLERSLIE AVE
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1513
Practice Address - Country:US
Practice Address - Phone:804-520-1655
Practice Address - Fax:804-520-8595
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001789103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical