Provider Demographics
NPI:1073088662
Name:KENDRICK, GISELLE (LLMSW)
Entity type:Individual
Prefix:
First Name:GISELLE
Middle Name:
Last Name:KENDRICK
Suffix:
Gender:
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 S ROCHESTER RD # 1229
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-3534
Mailing Address - Country:US
Mailing Address - Phone:313-403-3675
Mailing Address - Fax:
Practice Address - Street 1:1480 N M 52 STE 1
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-1025
Practice Address - Country:US
Practice Address - Phone:989-723-8230
Practice Address - Fax:989-723-8230
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MI68011099771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)