Provider Demographics
NPI:1447735816
Name:KINSER-WITHEY, ANDREA C (RBT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:C
Last Name:KINSER-WITHEY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:C
Other - Last Name:KINSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2820 SHADELANDS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2525
Mailing Address - Country:US
Mailing Address - Phone:530-417-1065
Mailing Address - Fax:
Practice Address - Street 1:2820 SHADELANDS DR STE 200
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2525
Practice Address - Country:US
Practice Address - Phone:707-399-9413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician