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Individual

KENDAL SIMEON BROWN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LCAS

Contact information

Practice address
4830 TUTELO TRL, WINSTON SALEM, NC 27127-9419
(540) 629-3308
Mailing address
4830 TUTELO TRL, WINSTON SALEM, NC 27127-9419
(540) 629-3308

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCAS-25015
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
LCAC-25015
NC
Enumeration date
06/09/2019
Last updated
06/09/2019
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