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General NPI Number Information
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NPI Number | 1073181814
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Entity Type | Individual
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Provider Name | JOHN RANDALL STINSON CADACII
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Gender | Male
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Dates
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Enumeration Date | 06/17/2021
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Last Update Date | 06/17/2021
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Provider Practice Location Address
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Address Line | 1030 E MORGAN ST
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City | MARTINSVILLE
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State | IN
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Zip | 46151-1743
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Country | US
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Telephone | 812-558-0574
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Fax |
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Provider Business Mailing Address
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Address Line | 7613 PIPESTONE DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46217-9220
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Country | US
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Telephone | 317-652-9046
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CII-1980
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License Number State | IN
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