Provider Demographics
NPI:1629604194
Name:ALEX, KENDRA PEARL (LCSW)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:PEARL
Last Name:ALEX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2181 ORANGE AVE E
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-6144
Mailing Address - Country:US
Mailing Address - Phone:832-317-7471
Mailing Address - Fax:
Practice Address - Street 1:2181 ORANGE AVE E
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32311-6144
Practice Address - Country:US
Practice Address - Phone:832-317-7471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-17
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical