Doctor Name: | MR. KEVIN DOUGLAS HENDRICKSON |
NPI Number: | 1275750226 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | L.C.S.W., B.C.E.T.S. |
License Number: | C004827 |
Business Practice Address: | 303 Fairground Rd Spindale, NC - 28160 |
Business Phone Number: | 8282882757 |
Business Fax Number: | |
Mailing Address: | 171 Moonseed Trl, BOSTIC |
State: | NC |
Postal Code: | 280189702 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 04/19/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | C004827 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |