Provider Demographics
NPI:1518781467
Name:HER, KINSON (RADT #R1581180924)
Entity type:Individual
Prefix:
First Name:KINSON
Middle Name:
Last Name:HER
Suffix:
Gender:M
Credentials:RADT #R1581180924
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442-1552
Mailing Address - Country:US
Mailing Address - Phone:805-772-2212
Mailing Address - Fax:
Practice Address - Street 1:2460 MAIN ST
Practice Address - Street 2:
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-1552
Practice Address - Country:US
Practice Address - Phone:805-772-2212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1581180924101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)