Individual
WANDA MARIE KENNEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCDC, LSBW
Contact information
Practice address
6563 HIGHLAND RD, GILMER, TX 75645-8279
(903) 734-5592
Mailing address
6563 HIGHLAND RD, GILMER, TX 75645-8279
(903) 734-5592
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
5922
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5922
LCDC
TX
01
—
S23305
LBSW
TX
Enumeration date
05/05/2006
Last updated
09/17/2007
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