Provider Demographics
NPI:1699935833
Name:BARDONILLE, KISHA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KISHA
Middle Name:
Last Name:BARDONILLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 DURHAM CHAPEL HILL BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2694
Mailing Address - Country:US
Mailing Address - Phone:919-402-0323
Mailing Address - Fax:919-402-9435
Practice Address - Street 1:3308 DURHAM CHAPEL HILL BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2694
Practice Address - Country:US
Practice Address - Phone:919-402-0323
Practice Address - Fax:919-402-9435
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0058171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical