Provider Demographics
NPI:1073181814
Name:STINSON, JOHN RANDALL (CADACII)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:RANDALL
Last Name:STINSON
Suffix:
Gender:M
Credentials:CADACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7613 PIPESTONE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-9220
Mailing Address - Country:US
Mailing Address - Phone:317-652-9046
Mailing Address - Fax:
Practice Address - Street 1:1030 E MORGAN ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-1743
Practice Address - Country:US
Practice Address - Phone:812-558-0574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCII-1980101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)