Provider Demographics
NPI:1700489739
Name:MCCALLISTER, KENDRA MICHELLE (CADC, MHRT/C, CRMA)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:MICHELLE
Last Name:MCCALLISTER
Suffix:
Gender:F
Credentials:CADC, MHRT/C, CRMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CARRIER WOOD RD APT 59
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7188
Mailing Address - Country:US
Mailing Address - Phone:207-239-1160
Mailing Address - Fax:
Practice Address - Street 1:420 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2823
Practice Address - Country:US
Practice Address - Phone:207-523-4129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC7137101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)