Provider Demographics
NPI:1790318459
Name:KUYKENDALL, ERIN SULLIVAN
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:SULLIVAN
Last Name:KUYKENDALL
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 1:91-2128 OLD FORT WEAVER ROAD
Mailing Address - Street 2:
Mailing Address - City:EWA
Mailing Address - State:HI
Mailing Address - Zip Code:96706
Mailing Address - Country:US
Mailing Address - Phone:808-589-1829
Mailing Address - Fax:
Practice Address - Street 1:91-2128 OLD FORT WEAVER ROAD
Practice Address - Street 2:
Practice Address - City:EWA
Practice Address - State:HI
Practice Address - Zip Code:96706
Practice Address - Country:US
Practice Address - Phone:808-589-1829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health