Provider Demographics
NPI:1558970947
Name:LEE, KENDRA LYNICE
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:LYNICE
Last Name:LEE
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 1:215 WALNUT ST STE 2
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5254
Mailing Address - Country:US
Mailing Address - Phone:251-406-5886
Mailing Address - Fax:
Practice Address - Street 1:215 WALNUT ST STE 2
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5254
Practice Address - Country:US
Practice Address - Phone:251-406-5886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1621-4427C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical