Provider Demographics
NPI:1952011611
Name:DIXON, KENDRA (LMHC)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:13324 TELECOM DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-0938
Mailing Address - Country:US
Mailing Address - Phone:813-419-3386
Mailing Address - Fax:
Practice Address - Street 1:13324 TELECOM DR
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33637-0938
Practice Address - Country:US
Practice Address - Phone:813-419-3386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH21361101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health