Healthcare Provider Details

I. General information

NPI: 1215369061
Provider Name (Legal Business Name): KENDRA ALICE YAKOVLEFF ADDICTION COUSELOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2013
Last Update Date: 08/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 PLAINFIELD RD
WEST LEBANON NH
03784-2001
US

IV. Provider business mailing address

28 ELM ST
CHARLESTOWN NH
03603-5006
US

V. Phone/Fax

Practice location:
  • Phone: 603-298-2146
  • Fax:
Mailing address:
  • Phone: 603-826-3704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number101YA0400X
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: