Provider Demographics
NPI:1912745647
Name:KENDALL, MARK (MSW)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:KENDALL
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 BILTMORE AVE # 100
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4504
Mailing Address - Country:US
Mailing Address - Phone:828-367-9374
Mailing Address - Fax:828-252-9691
Practice Address - Street 1:356 BILTMORE AVE # 100
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4504
Practice Address - Country:US
Practice Address - Phone:828-367-9374
Practice Address - Fax:828-252-9691
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-30102101YA0400X
NCP0207771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty