Healthcare Provider Details

I. General information

NPI: 1811665649
Provider Name (Legal Business Name): KENDALL CAMILLE DOYAL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2021
Last Update Date: 09/06/2021
Certification Date: 09/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 FORTRESS BLVD
MORGANTOWN WV
26508-1351
US

IV. Provider business mailing address

14781 POMERADO RD # 530
POWAY CA
92064-2802
US

V. Phone/Fax

Practice location:
  • Phone: 304-225-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9483
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701007926
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: