Provider Demographics
NPI:1871007674
Name:KENDRICK, NICKALA JIMELE (LMSW)
Entity Type:Individual
Prefix:
First Name:NICKALA
Middle Name:JIMELE
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 PARTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-3044
Mailing Address - Country:US
Mailing Address - Phone:229-296-7117
Mailing Address - Fax:
Practice Address - Street 1:270 CARPENTER DRIVE NE
Practice Address - Street 2:400
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:678-460-0345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW008114390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program