Provider Demographics
NPI:1558028654
Name:HART, KENDRA (LADAC II, NCC)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:LADAC II, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 DALTON ST
Mailing Address - Street 2:
Mailing Address - City:ALCOA
Mailing Address - State:TN
Mailing Address - Zip Code:37701-2325
Mailing Address - Country:US
Mailing Address - Phone:865-556-3215
Mailing Address - Fax:
Practice Address - Street 1:2001 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1217
Practice Address - Country:US
Practice Address - Phone:865-633-0353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1477101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)