Provider Demographics
NPI:1295916328
Name:KENDRICK, LAURENCE L (LPCC-S, LICDC)
Entity type:Individual
Prefix:MR
First Name:LAURENCE
Middle Name:L
Last Name:KENDRICK
Suffix:
Gender:M
Credentials:LPCC-S, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12647 TOWNSHIP ROAD 503
Mailing Address - Street 2:
Mailing Address - City:BIG PRAIRIE
Mailing Address - State:OH
Mailing Address - Zip Code:44611-9629
Mailing Address - Country:US
Mailing Address - Phone:330-749-9012
Mailing Address - Fax:
Practice Address - Street 1:12647 TOWNSHIP ROAD 503
Practice Address - Street 2:
Practice Address - City:BIG PRAIRIE
Practice Address - State:OH
Practice Address - Zip Code:44611-9629
Practice Address - Country:US
Practice Address - Phone:330-749-9012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0701114-SUPV101YM0800X
OHLICDC.111019101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)