Basic Information
| Provider Information | |||||||||
| NPI: | 1437607801 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRENDERGAST | ||||||||
| FirstName: | KENLEIGH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 SUMMER LADY LN | ||||||||
| Address2: | |||||||||
| City: | BOILING SPRINGS | ||||||||
| State: | SC | ||||||||
| PostalCode: | 293165868 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 250 DEWEY AVE | ||||||||
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| City: | SPARTANBURG | ||||||||
| State: | SC | ||||||||
| PostalCode: | 293033009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645850366 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2016 | ||||||||
| LastUpdateDate: | 09/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.