Provider Demographics
NPI:1407302979
Name:HILL, KYNATTAH (MS COUNSELING PSYCHO)
Entity Type:Individual
Prefix:
First Name:KYNATTAH
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:MS COUNSELING PSYCHO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 SANTA CLARA AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610
Mailing Address - Country:US
Mailing Address - Phone:510-601-1929
Mailing Address - Fax:510-610-1947
Practice Address - Street 1:166 SANTA CLARA AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610
Practice Address - Country:US
Practice Address - Phone:510-601-1929
Practice Address - Fax:510-610-1947
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-25
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96537106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty