Provider Demographics
NPI:1417743741
Name:GREENE-HERRON, KENDALL (LMSW)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:GREENE-HERRON
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 OLA DALE DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-7196
Mailing Address - Country:US
Mailing Address - Phone:404-735-4050
Mailing Address - Fax:
Practice Address - Street 1:9841 WASHINGTONIAN BLVD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-5389
Practice Address - Country:US
Practice Address - Phone:833-366-3934
Practice Address - Fax:833-630-0540
Is Sole Proprietor?:No
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC104100000X
VA104100000X
MD32787104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker