Provider Demographics
NPI:1790169332
Name:KENDRICK, TIARA
Entity Type:Individual
Prefix:MISS
First Name:TIARA
Middle Name:
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TIARA
Other - Middle Name:
Other - Last Name:DAWKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1855 E DUBLIN GRANVILLE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-3516
Mailing Address - Country:US
Mailing Address - Phone:614-267-7003
Mailing Address - Fax:
Practice Address - Street 1:1335 DUBLIN RD
Practice Address - Street 2:SUITE 205 C
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1000
Practice Address - Country:US
Practice Address - Phone:614-437-9910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1500460-TRNE390200000X
OHE.1901153101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program