Individual
JENNIFER MICHELLE KINCAID-SHORES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADAC II, MAT, NCAC
Contact information
Practice address
1481 W 10TH ST, INDIANAPOLIS, IN 46202-2803
(317) 554-0000
Mailing address
1481 W 10TH ST, INDIANAPOLIS, IN 46202-2803
(317) 554-0000
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
C2-5145
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35-1866298
—
IN
Enumeration date
02/24/2016
Last updated
08/07/2020
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