Provider Demographics
NPI:1053088468
Name:CUNHA, NINA MARI ANN
Entity type:Individual
Prefix:MRS
First Name:NINA
Middle Name:MARI ANN
Last Name:CUNHA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:NINA
Other - Middle Name:MARI ANN
Other - Last Name:EGBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4001 W END RD STE 3
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-9628
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4001 W END RD STE 3
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-9628
Practice Address - Country:US
Practice Address - Phone:707-810-6791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138526101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health