Provider Demographics
NPI:1710593447
Name:ARTIS, KENDRA ANISSA (RES IN COUNSELING)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:ANISSA
Last Name:ARTIS
Suffix:
Gender:F
Credentials:RES IN COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 AMBOY CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-4234
Mailing Address - Country:US
Mailing Address - Phone:757-232-7009
Mailing Address - Fax:
Practice Address - Street 1:5005 AMBOY COURT
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6028
Practice Address - Country:US
Practice Address - Phone:757-318-0002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701012295101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0704010568Medicaid