Provider Demographics
NPI:1700487071
Name:KENDIG, AMANDA PAIGE (LCSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:PAIGE
Last Name:KENDIG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 RIVERSIDE DRIVE, BUILDING 6
Mailing Address - Street 2:SUITE 100E
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039
Mailing Address - Country:US
Mailing Address - Phone:510-858-6775
Mailing Address - Fax:
Practice Address - Street 1:5000 RIVERSIDE DR BLDG 6
Practice Address - Street 2:STE 100E
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-4316
Practice Address - Country:US
Practice Address - Phone:256-813-8378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX606381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX60638OtherLCSW LICENSE NUMBER