Provider Demographics
NPI:1245398494
Name:WILLIAMS, KENDRA NOELLE (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:NOELLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 HIGUERA ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3861
Mailing Address - Country:US
Mailing Address - Phone:805-440-7523
Mailing Address - Fax:
Practice Address - Street 1:1989 VICENTE DR
Practice Address - Street 2:A
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-6863
Practice Address - Country:US
Practice Address - Phone:805-781-4315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44859106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist