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NPI Code Detail

MEDICARE: KENDALL'S INDEPENDENCE AND DEVELOPMENTAL SERVICES

MEDICARE: KENDALL'S INDEPENDENCE AND DEVELOPMENTAL SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1104767730
Entity Type Code : Organization
Provider Name (Legal Business Name) : KENDALL'S INDEPENDENCE AND DEVELOPMENTAL SERVICES
Provider Business Mailing Address
First Line : 3900 CHAMBERLAYNE AVE
Second Line :
City : RICHMOND
State : VA
Zip : 23227-4202
Country : US
Telephone Number : 804-304-7014
Fax Number :
Provider Business Practice Location Address
First Line : 3900 CHAMBERLAYNE AVE
Second Line :
City : RICHMOND
State : VA
Zip : 23227-4202
Country : US
Telephone Number : 804-304-7014
Fax Number :
Authorized Official
Title or Position : PROGRAM DIRECTOR
Name : MR. LAMAR BLIZZARD BLIZZARD
Credential : QMHP
Telephone Number : 804-304-7014
Provider Enumeration Date : 04/06/2026
Last Update Date : 04/06/2026

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Directions to “KENDALL'S INDEPENDENCE AND DEVELOPMENTAL SERVICES ” Practice Location

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