Provider Demographics
NPI:1578851424
Name:CHISOLM, KENDRA VERNAE (LCSW, CSAC)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:VERNAE
Last Name:CHISOLM
Suffix:
Gender:F
Credentials:LCSW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 FAIRFAX DRIVE
Mailing Address - Street 2:SUITE 62
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203
Mailing Address - Country:US
Mailing Address - Phone:703-216-9688
Mailing Address - Fax:
Practice Address - Street 1:3801 FAIRFAX DRIVE
Practice Address - Street 2:SUITE 62
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203
Practice Address - Country:US
Practice Address - Phone:703-216-9688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040075141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical