Provider Demographics
NPI:1497361505
Name:LENDORE, KISHA MONIQUE
Entity Type:Individual
Prefix:MRS
First Name:KISHA
Middle Name:MONIQUE
Last Name:LENDORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2133 ROWLAND POND DR
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRING
Mailing Address - State:NC
Mailing Address - Zip Code:27592-7575
Mailing Address - Country:US
Mailing Address - Phone:919-946-6678
Mailing Address - Fax:
Practice Address - Street 1:2133 ROWLAND POND DR
Practice Address - Street 2:
Practice Address - City:WILLOW SPRING
Practice Address - State:NC
Practice Address - Zip Code:27592-7575
Practice Address - Country:US
Practice Address - Phone:919-946-6678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15925101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional