Individual
CAROLYN JANE KILDEGAARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
111 EDGARTOWN ROAD, VINEYARD HAVEN, MA 02568
(508) 693-7900
Mailing address
PO BOX 1385, EDGARTOWN, MA 02539-1385
(508) 693-7900
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
09/22/2010
Last updated
09/22/2010
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