Healthcare Provider Details

I. General information

NPI: 1043866395
Provider Name (Legal Business Name): KENDRA MICHAEL BCBA, LPA, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 03/22/2026
Certification Date: 03/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16701 MELFORD BLVD STE 400
BOWIE MD
20715-4411
US

IV. Provider business mailing address

16701 MELFORD BLVD STE 400
BOWIE MD
20715-4411
US

V. Phone/Fax

Practice location:
  • Phone: 704-533-0147
  • Fax:
Mailing address:
  • Phone: 704-533-0147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberA01018
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-35527
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: