Healthcare Provider Details

I. General information

NPI: 1720626120
Provider Name (Legal Business Name): SHEILA KENDRICK-WOODSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2019
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 WOODWINDS CT
KATHLEEN GA
31047-1112
US

IV. Provider business mailing address

113 WOODWINDS CT
KATHLEEN GA
31047-1112
US

V. Phone/Fax

Practice location:
  • Phone: 478-319-7102
  • Fax:
Mailing address:
  • Phone: 478-319-7102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC010618
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: