Provider Demographics
NPI:1265655294
Name:KIDD, SYLVIA MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:MARIE
Last Name:KIDD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 GLACIER HIGHWAY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-8097
Mailing Address - Country:US
Mailing Address - Phone:907-790-9622
Mailing Address - Fax:907-790-9622
Practice Address - Street 1:9000 GLACIER HIGHWAY
Practice Address - Street 2:SUITE 204
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8097
Practice Address - Country:US
Practice Address - Phone:907-790-9622
Practice Address - Fax:907-790-9622
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK15101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK15OtherLPC