Healthcare Provider Details

I. General information

NPI: 1114882818
Provider Name (Legal Business Name): DONNIE HARKINS CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3663 N LAKEHARBOR LN
BOISE ID
83703-6913
US

IV. Provider business mailing address

223 W WASHINGTON AVE
HOMEDALE ID
83628-3111
US

V. Phone/Fax

Practice location:
  • Phone: 208-286-4274
  • Fax:
Mailing address:
  • Phone: 208-965-7093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCADC-5102
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: