Provider Demographics
NPI:1851605331
Name:KENDRICK, JON (LCSW)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:KENDRICK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 MYRTLE ST NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-4146
Mailing Address - Country:US
Mailing Address - Phone:678-770-8900
Mailing Address - Fax:
Practice Address - Street 1:5901 PEACHTREE DUNWOODY RD STE A-225
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5382
Practice Address - Country:US
Practice Address - Phone:404-955-9788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2022-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0047501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical