Healthcare Provider Details

I. General information

NPI: 1942128582
Provider Name (Legal Business Name): THEODORE KINCAID
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 E TUDOR RD STE 105
ANCHORAGE AK
99507-1259
US

IV. Provider business mailing address

3701 E TUDOR RD STE 105
ANCHORAGE AK
99507-1259
US

V. Phone/Fax

Practice location:
  • Phone: 907-865-5833
  • Fax: 832-225-3911
Mailing address:
  • Phone: 907-865-5833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: