Individual
SHELLY LYNN NIBLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDC L
Contact information
Practice address
10200, KENAI SOUR HWY, KENAI, AK 99611
(907) 283-3658
Mailing address
PO BOX 882, KENAI, AK 99611-0882
(907) 283-3658
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
05/03/2019
Last updated
05/03/2019
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