Provider Demographics
NPI:1790183606
Name:KINSER-HARRIS, TONI J
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:J
Last Name:KINSER-HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:J
Other - Last Name:KINSER-HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CADC 1
Mailing Address - Street 1:315 14TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-3319
Mailing Address - Country:US
Mailing Address - Phone:541-905-2104
Mailing Address - Fax:
Practice Address - Street 1:3871 FAIRVIEW INDUSTRIAL DR SE STE 150
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1172
Practice Address - Country:US
Practice Address - Phone:541-391-9762
Practice Address - Fax:503-315-2019
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11-03-18101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)