Individual
KENDALL JASPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
223 W MOREHEAD ST, CHARLOTTE, NC 28202-1521
(980) 819-5692
(980) 819-5694
Mailing address
223 W MOREHEAD ST, CHARLOTTE, NC 28202-1521
(980) 819-5692
(980) 819-5694
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
4088
NC
103TC0700X
Clinical Psychologist
Primary
4088
NC
103TC2200X
Clinical Child & Adolescent Psychologist
4088
NC
251S00000X
Community/Behavioral Health Agency
4088
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6107205
—
NC
Enumeration date
03/27/2007
Last updated
04/04/2016
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