Provider Demographics
NPI:1821827619
Name:JOHNSON, KENDRA NICOLE (ALC)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:NICOLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 REGENT DR
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-4669
Mailing Address - Country:US
Mailing Address - Phone:205-917-0516
Mailing Address - Fax:
Practice Address - Street 1:512 REGENT DR
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-4669
Practice Address - Country:US
Practice Address - Phone:205-917-0516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04770101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health