Provider Demographics
NPI:1942353966
Name:WOOLLEY, KENDRA E (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:E
Last Name:WOOLLEY
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 W DIAMOND AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-1416
Mailing Address - Country:US
Mailing Address - Phone:240-626-3079
Mailing Address - Fax:
Practice Address - Street 1:814 W DIAMOND AVE STE 310
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-1416
Practice Address - Country:US
Practice Address - Phone:240-626-3079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-21
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD121011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical