Healthcare Provider Details

I. General information

NPI: 1457265795
Provider Name (Legal Business Name): ZACHARY ADAM KENDRICK PRSS-SUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 LOGAN ST STE 201
WILLIAMSON WV
25661-3639
US

IV. Provider business mailing address

101 LOGAN ST STE 201
WILLIAMSON WV
25661-3639
US

V. Phone/Fax

Practice location:
  • Phone: 304-235-3570
  • Fax: 304-235-2654
Mailing address:
  • Phone: 304-235-3570
  • Fax: 304-235-2654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number23-9184
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: