Provider Demographics
NPI:1093172470
Name:FARNELL, KINCIE (CERTIFIED ADDICTION)
Entity Type:Individual
Prefix:
First Name:KINCIE
Middle Name:
Last Name:FARNELL
Suffix:
Gender:F
Credentials:CERTIFIED ADDICTION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W GRANT ST APT 2008
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-3961
Mailing Address - Country:US
Mailing Address - Phone:772-333-6964
Mailing Address - Fax:
Practice Address - Street 1:100 W GRANT ST APT 2008
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-3961
Practice Address - Country:US
Practice Address - Phone:772-333-6964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-15
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CMHP100035101Y00000X
FLCMHP100035101YM0800X, 101YP2500X
FL803868405300000X
FLADC-000245-2014101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No405300000XOther Service ProvidersPrevention Professional