1366694580 NPI number — MRS. KENDRA MCILVEE TWITTY M.A., LPC

Table of content: MRS. KENDRA MCILVEE TWITTY M.A., LPC (NPI 1366694580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366694580 NPI number — MRS. KENDRA MCILVEE TWITTY M.A., LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TWITTY
Provider First Name:
KENDRA
Provider Middle Name:
MCILVEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366694580
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 510
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIDGELAND
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29936-2609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-812-1018
Provider Business Mailing Address Fax Number:
843-717-4233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
762 ETHERIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YEMASSEE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29945-8834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-812-1018
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  4940 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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