Provider Demographics
NPI:1043731821
Name:KUNKLE, ELIZABETH CARISA (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CARISA
Last Name:KUNKLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31537 RANCHO PUEBLO RD STE 102
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-4841
Mailing Address - Country:US
Mailing Address - Phone:833-867-4642
Mailing Address - Fax:360-462-2751
Practice Address - Street 1:31537 RANCHO PUEBLO RD STE 102
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-4841
Practice Address - Country:US
Practice Address - Phone:833-867-4642
Practice Address - Fax:360-462-2751
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2025-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1299351041C0700X
CAASW855021041C0700X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical