Provider Demographics
NPI:1740754662
Name:DUNCAN, MIKHAILA NOELLE
Entity Type:Individual
Prefix:
First Name:MIKHAILA
Middle Name:NOELLE
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-1663
Mailing Address - Country:US
Mailing Address - Phone:831-420-0120
Mailing Address - Fax:831-420-1057
Practice Address - Street 1:155 WILLOWBROOK DR
Practice Address - Street 2:
Practice Address - City:BEN LOMOND
Practice Address - State:CA
Practice Address - Zip Code:95005-9714
Practice Address - Country:US
Practice Address - Phone:831-336-5196
Practice Address - Fax:831-464-2641
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health