Provider Demographics
NPI:1194052217
Name:PERKINS, KENDRA G
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:G
Last Name:PERKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 937
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640-0937
Mailing Address - Country:US
Mailing Address - Phone:336-246-9631
Mailing Address - Fax:
Practice Address - Street 1:1232 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-2625
Practice Address - Country:US
Practice Address - Phone:336-838-4883
Practice Address - Fax:336-838-4891
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPC LICENSE ELIGIBLE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health