Individual
MRS. JULIET C KINKADE-BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MFTI, PCCI
Contact information
Practice address
1709 MOON ST NE, ALBUQUERQUE, NM 87112-3935
(505) 271-0329
Mailing address
1709 MOON ST NE, ALBUQUERQUE, NM 87112-3935
(505) 271-0329
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
IMF76250
CA
101YM0800X
Mental Health Counselor
PCCI788
CA
106H00000X
Marriage & Family Therapist
Primary
0181841
NM
Other
Enumeration date
08/01/2012
Last updated
06/18/2024
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