Provider Demographics
NPI:1245400746
Name:KURKUL, ERIC T
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:T
Last Name:KURKUL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 NEOTOMAS AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-7575
Mailing Address - Country:US
Mailing Address - Phone:707-565-6971
Mailing Address - Fax:
Practice Address - Street 1:1430 NEOTOMAS AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-7575
Practice Address - Country:US
Practice Address - Phone:707-565-6971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)