Provider Demographics
NPI:1316776958
Name:KINCAID, ERIN CLARK (CBC)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:CLARK
Last Name:KINCAID
Suffix:
Gender:F
Credentials:CBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 HIGHVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-8245
Mailing Address - Country:US
Mailing Address - Phone:972-834-9322
Mailing Address - Fax:
Practice Address - Street 1:412 HIGHVIEW CIR
Practice Address - Street 2:
Practice Address - City:ROYSE CITY
Practice Address - State:TX
Practice Address - Zip Code:75189-8245
Practice Address - Country:US
Practice Address - Phone:972-834-9322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA00101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty