Provider Demographics
NPI:1053005520
Name:GAINEY, KENDRA
Entity type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:
Last Name:GAINEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 GAINEY LN
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:NC
Mailing Address - Zip Code:28438-8955
Mailing Address - Country:US
Mailing Address - Phone:910-212-2727
Mailing Address - Fax:
Practice Address - Street 1:64 GAINEY LN
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:NC
Practice Address - Zip Code:28438-8955
Practice Address - Country:US
Practice Address - Phone:910-212-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NCP0210471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)