Provider Demographics
NPI:1023432747
Name:HENRY, KENDRA (LPCC, LADC)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 2ND ST SW UNIT 1
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-4421
Mailing Address - Country:US
Mailing Address - Phone:507-258-4458
Mailing Address - Fax:507-299-9577
Practice Address - Street 1:2212 2ND ST SW UNIT 1
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-4421
Practice Address - Country:US
Practice Address - Phone:507-258-4458
Practice Address - Fax:507-299-9577
Is Sole Proprietor?:No
Enumeration Date:2014-02-17
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1264101YP2500X
MNCC01264101YP2500X
MN303799101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)