Provider Demographics
NPI:1811504574
Name:TOLEN, KACI
Entity type:Individual
Prefix:
First Name:KACI
Middle Name:
Last Name:TOLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2085 SOLANO WAY APT A
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-4781
Mailing Address - Country:US
Mailing Address - Phone:925-393-9941
Mailing Address - Fax:
Practice Address - Street 1:2085 SOLANO WAY APT A
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-4781
Practice Address - Country:US
Practice Address - Phone:925-393-9941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1402650820101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)