Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | PC005594 | PA |
N | 101YS0200X | School Counselor |
NPI | 1164963112 |
---|---|
Provider Name | Cory Kunicky |
First Address | North Huntingdon, PA 15642 |
Second Address | Greensburgh, PA 15601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2017 |
Last Update Date | 10/03/2017 |