Provider Demographics
NPI:1588968713
Name:WOODY-SIMMONS, KENDRA (LPC, CAC, SAP, NCC)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:WOODY-SIMMONS
Suffix:
Gender:F
Credentials:LPC, CAC, SAP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 CREEK STONE WAY
Mailing Address - Street 2:
Mailing Address - City:HANAHAN
Mailing Address - State:SC
Mailing Address - Zip Code:29410-4739
Mailing Address - Country:US
Mailing Address - Phone:843-437-6859
Mailing Address - Fax:866-496-9934
Practice Address - Street 1:6650 RIVERS AVE
Practice Address - Street 2:SUITE 124
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-4809
Practice Address - Country:US
Practice Address - Phone:843-475-9096
Practice Address - Fax:866-496-9934
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC09052613101YA0400X
SC5234101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC255933OtherNATIONAL CERTIFIED COUNSELOR
SC5234OtherLICENSED PROFESSIONAL COUNSELOR
SC13334OtherSUBSTANCE ABUSE PROFESSIONAL
SC09052613OtherCERTIFIED ADDICTION COUNSELOR