Provider Demographics
NPI:1396181947
Name:KINGSTON, PENNY (CADC II)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:KINGSTON
Suffix:
Gender:F
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 E 17TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-8521
Mailing Address - Country:US
Mailing Address - Phone:714-542-0400
Mailing Address - Fax:
Practice Address - Street 1:1525 E 17TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8521
Practice Address - Country:US
Practice Address - Phone:714-542-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)