Provider Demographics
NPI:1366694580
Name:TWITTY, KENDRA MCILVEE (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:MCILVEE
Last Name:TWITTY
Suffix:
Gender:F
Credentials:MA, LPC
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 510
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-2609
Mailing Address - Country:US
Mailing Address - Phone:843-812-1018
Mailing Address - Fax:843-717-4233
Practice Address - Street 1:762 ETHERIDGE RD
Practice Address - Street 2:
Practice Address - City:YEMASSEE
Practice Address - State:SC
Practice Address - Zip Code:29945-8834
Practice Address - Country:US
Practice Address - Phone:843-812-1018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4940101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional