Healthcare Provider Details

I. General information

NPI: 1205540556
Provider Name (Legal Business Name): JEMELIA KENDALL MA, LCAS-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2023
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 LYNNDALE CT STE C
GREENVILLE NC
27858-5462
US

IV. Provider business mailing address

2933 JESSICA DR # A
WINTERVILLE NC
28590-8334
US

V. Phone/Fax

Practice location:
  • Phone: 252-752-8602
  • Fax:
Mailing address:
  • Phone: 910-474-3741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: