Healthcare Provider Details

I. General information

NPI: 1669114161
Provider Name (Legal Business Name): MARGARET KUKLA CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

796 OAK ST
PAINESVILLE OH
44077-4335
US

IV. Provider business mailing address

9083 MENTOR AVE
MENTOR OH
44060-6462
US

V. Phone/Fax

Practice location:
  • Phone: 440-205-2673
  • Fax:
Mailing address:
  • Phone: 440-255-0678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDCIII.162560
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2207735
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: