Provider Demographics
NPI:1750823654
Name:KUNKLE, SARA GRUNTHALER (MS, LPES)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:GRUNTHALER
Last Name:KUNKLE
Suffix:
Gender:F
Credentials:MS, LPES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 FIVE FORK PLAZA CT STE B
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-5460
Mailing Address - Country:US
Mailing Address - Phone:864-663-2403
Mailing Address - Fax:
Practice Address - Street 1:11 FIVE FORK PLAZA CT STE B
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-5460
Practice Address - Country:US
Practice Address - Phone:864-663-2403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4562103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool