Provider Demographics
NPI:1447655634
Name:GULLEDGE, KENDAL KAE BLACKWELDER (LCSW, LCAS)
Entity type:Individual
Prefix:
First Name:KENDAL
Middle Name:KAE BLACKWELDER
Last Name:GULLEDGE
Suffix:
Gender:
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2634 ANDREW POINT DR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-5455
Mailing Address - Country:US
Mailing Address - Phone:704-657-4665
Mailing Address - Fax:
Practice Address - Street 1:2485 N NC 16 BUSINESS HWY STE 100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-8256
Practice Address - Country:US
Practice Address - Phone:704-657-4665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-30
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-21179101YA0400X
NCC0104911041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)