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General NPI Number Information
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NPI Number | 1952078693
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Entity Type | Individual
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Provider Name | KIERA MCGINLEY KUNKLE MA
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Gender | Female
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Dates
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Enumeration Date | 08/29/2021
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Last Update Date | 08/29/2021
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Provider Practice Location Address
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Address Line | 107 E MAIN ST STE 204
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City | NORTHVILLE
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State | MI
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Zip | 48167-1566
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Country | US
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Telephone | 248-764-5751
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Fax |
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Provider Business Mailing Address
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Address Line | 1321 ORLEANS ST APT 1610
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City | DETROIT
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State | MI
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Zip | 48207-2950
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Country | US
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Telephone | 412-715-5790
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6352000256
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License Number State | MI
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