Healthcare Provider Details

I. General information

NPI: 1407020886
Provider Name (Legal Business Name): JONATHAN DALE KIRKENDALL MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 QUINCY ST NE
WASHINGTON DC
20017-2615
US

IV. Provider business mailing address

1325 QUINCY ST NE
WASHINGTON DC
20017-2615
US

V. Phone/Fax

Practice location:
  • Phone: 202-526-4445
  • Fax: 202-526-7401
Mailing address:
  • Phone: 202-526-4445
  • Fax: 202-526-7401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC13592
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: