Provider Demographics
NPI:1154161891
Name:PEGG, KENDRA MARIE (BA)
Entity type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:MARIE
Last Name:PEGG
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MISS
Other - First Name:KENDRA
Other - Middle Name:MARIE
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:1500 W 5TH AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661-3457
Mailing Address - Country:US
Mailing Address - Phone:859-779-1140
Mailing Address - Fax:
Practice Address - Street 1:1609 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661-3006
Practice Address - Country:US
Practice Address - Phone:304-235-0026
Practice Address - Fax:304-235-0028
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health