Doctor Name: | ERICKA VIOLET KIS |
NPI Number: | 1265750137 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PHD |
License Number: | PSY 22828 |
Business Practice Address: | 3102 E Highland Ave Patton, CA - 923697813 |
Business Phone Number: | 9094257552 |
Business Fax Number: | 9094256407 |
Mailing Address: | 1600 9th St Ste 205, SACRAMENTO |
State: | CA |
Postal Code: | 958146435 |
Phone Number: | 9166542431 |
Fax Number: | 9166543186 |
NPI Enumeration Date: | 05/17/2010 |
NPI Last Update Date: | 05/17/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PSY 22828 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |