Provider Demographics
NPI:1720805120
Name:KINDRICK, KELLIE ANNE (LCSW)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:ANNE
Last Name:KINDRICK
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 1:408 N CEDAR BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-3607
Mailing Address - Country:US
Mailing Address - Phone:865-268-3852
Mailing Address - Fax:
Practice Address - Street 1:408 N CEDAR BLUFF RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-3607
Practice Address - Country:US
Practice Address - Phone:865-268-3852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN92981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical