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General NPI Number Information
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NPI Number | 1588968713
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Entity Type | Individual
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Provider Name | KENDRA WOODY-SIMMONS LPC, CAC, SAP, NCC
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Gender | Female
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Dates
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Enumeration Date | 01/03/2011
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Last Update Date | 01/03/2011
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Provider Practice Location Address
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Address Line | 6650 RIVERS AVE SUITE 124
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-4809
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Country | US
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Telephone | 843-475-9096
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Fax | 866-496-9934
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Provider Business Mailing Address
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Address Line | 1233 CREEK STONE WAY
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City | HANAHAN
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State | SC
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Zip | 29410-4739
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Country | US
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Telephone | 843-437-6859
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Fax | 866-496-9934
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 09052613
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5234
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License Number State | SC
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