Provider Demographics
NPI:1649396904
Name:TONKIN, KARIN M (PHD,HSPP)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:M
Last Name:TONKIN
Suffix:
Gender:F
Credentials:PHD,HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3937 SUNSET BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-2423
Mailing Address - Country:US
Mailing Address - Phone:803-900-4890
Mailing Address - Fax:803-931-3891
Practice Address - Street 1:6640 INTECH BLVD
Practice Address - Street 2:SUITE 190
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-2011
Practice Address - Country:US
Practice Address - Phone:317-295-0608
Practice Address - Fax:317-295-0622
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042162A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200856830Medicaid
IN200856830Medicaid