Healthcare Provider Details

I. General information

NPI: 1003342601
Provider Name (Legal Business Name): KRISTIN KENDRICK LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 POYDRAS ST STE B
NEW ORLEANS LA
70119-7561
US

IV. Provider business mailing address

4717 KAWANEE AVE
METAIRIE LA
70006-2718
US

V. Phone/Fax

Practice location:
  • Phone: 504-524-7205
  • Fax:
Mailing address:
  • Phone: 504-338-3298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: