Provider Demographics
NPI:1750905741
Name:KAUBA, JAKINI A (LCMHCA)
Entity type:Individual
Prefix:
First Name:JAKINI
Middle Name:A
Last Name:KAUBA
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 EUGENE CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2714
Mailing Address - Country:US
Mailing Address - Phone:336-365-8354
Mailing Address - Fax:336-365-2380
Practice Address - Street 1:418 EUGENE CT
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2714
Practice Address - Country:US
Practice Address - Phone:336-365-8354
Practice Address - Fax:336-365-2380
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15705101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional