Healthcare Provider Details

I. General information

NPI: 1356272371
Provider Name (Legal Business Name): KENDAL KRISTINE JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KENDAL KRISTINE PINNELL

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11940 CAROLINA PLACE PKWY STE 200
PINEVILLE NC
28134-7471
US

IV. Provider business mailing address

4109 SPRING ST
MATTHEWS NC
28105-7220
US

V. Phone/Fax

Practice location:
  • Phone: 704-541-9080
  • Fax:
Mailing address:
  • Phone: 530-570-5678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22947
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: