MEDICARE: LINDA KENDALL LPC

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
1	101YP2500X	Professional Counselor	3379	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	133HJ	OTHER	NC	BLUE CROSS BLUE SJIELD
2	549478	OTHER	NY	VALUE OPTIONS
3	2928	OTHER	NC	MEDCOST
4	366022	OTHER	NC	MANAGEDHEALTHNETWORK MHN

General Provider Information

NPI Number	:	1114012770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA KENDALL LPC

Provider Business Mailing Address
First Line	:	2005 CORBERRIE LN
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613-4315
Country	:	US
Telephone Number	:	919-696-6163
Fax Number	:	919-861-8893

Provider Business Practice Location Address
First Line	:	2005 CORBERRIE LN
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613-4315
Country	:	US
Telephone Number	:	919-696-6163
Fax Number	:	919-861-8893

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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