Provider Demographics
NPI:1730441312
Name:SCOTT, KENDRA TAWANNA (LPCA)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:TAWANNA
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 ARROWWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-2509
Mailing Address - Country:US
Mailing Address - Phone:336-601-2447
Mailing Address - Fax:
Practice Address - Street 1:12316 HAMPTON WAY DR
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6538
Practice Address - Country:US
Practice Address - Phone:336-601-2447
Practice Address - Fax:919-263-0323
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9349101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health