Healthcare Provider Details

I. General information

NPI: 1013445428
Provider Name (Legal Business Name): THOMAS JOSEPH KUCHINSKI CADC-I / CI07740517
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41002 COUNTY CENTER DR STE A-225
TEMECULA CA
92591-6051
US

IV. Provider business mailing address

44854 CAMINO ALAMOSA
TEMECULA CA
92592-1412
US

V. Phone/Fax

Practice location:
  • Phone: 951-600-6025
  • Fax:
Mailing address:
  • Phone: 858-232-0714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberRII06011215
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCI07740517
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCI07740517
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: