Provider Demographics
NPI:1588372346
Name:HARRIS, KENDAL F (LSATP, MAC, CSAC)
Entity type:Individual
Prefix:MRS
First Name:KENDAL
Middle Name:F
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LSATP, MAC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 GROVEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-4861
Mailing Address - Country:US
Mailing Address - Phone:804-986-3792
Mailing Address - Fax:
Practice Address - Street 1:3600 GROVEWOOD RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-4861
Practice Address - Country:US
Practice Address - Phone:804-986-3792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0718000524101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)