Provider Demographics
NPI:1831433895
Name:SHEALEY, KENDRA D
Entity type:Individual
Prefix:MS
First Name:KENDRA
Middle Name:D
Last Name:SHEALEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001ARGYLE FOREST BOULEVARD
Mailing Address - Street 2:SUITE 21, PMB 272
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-6127
Mailing Address - Country:US
Mailing Address - Phone:904-404-8113
Mailing Address - Fax:904-453-8668
Practice Address - Street 1:6001ARGYLE FOREST BOULEVARD
Practice Address - Street 2:SUITE 21, PMB 272
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-6127
Practice Address - Country:US
Practice Address - Phone:904-404-8113
Practice Address - Fax:904-453-8668
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101Y00000X
FLMH19995101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor