Healthcare Provider Details

I. General information

NPI: 1003873985
Provider Name (Legal Business Name): CAROL KENDRICK PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N MAIN ST
SPRINGDALE AR
72764-1302
US

IV. Provider business mailing address

501 N MAIN ST
SPRINGDALE AR
72764-1302
US

V. Phone/Fax

Practice location:
  • Phone: 479-751-5577
  • Fax: 479-756-2526
Mailing address:
  • Phone: 479-751-5577
  • Fax: 479-756-2526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberM9804022
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9301002
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number78-13E
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: