Mark Ronald Kisner, MSW, CADC-II

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

RA851306 Issued in CA

Practice address

316 Thalia St
Laguna Beach, CA 92651-2714

Phone

(714) 913-0852

Fax

(949) 497-3687

NPI assigned

Sep 9, 2008

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Laguna Beach Recovery

  • Substance Abuse Rehabilitation Facility
  • Laguna Beach, CA
  • NPI 1265680953
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1220918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1220918400000",
    "number": "1922257484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 THALIA ST",
            "city": "LAGUNA BEACH",
            "state": "CA",
            "postal_code": "926512714",
            "telephone_number": "714-913-0852",
            "fax_number": "949-497-3687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 THALIA ST",
            "city": "LAGUNA BEACH",
            "state": "CA",
            "postal_code": "926512714",
            "telephone_number": "714-913-0852",
            "fax_number": "949-497-3687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISNER",
        "first_name": "MARK",
        "middle_name": "RONALD",
        "name_prefix": "Mr.",
        "credential": "MSW, CADC-II",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-09-09",
        "last_updated": "2008-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "RA851306",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CERTIFICATION BOARD OF ALCOHOL AND DRUG COUNSELORS",
            "identifier": "RA851306",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Briana Kim
• David Edwin Kim, MD
• Ryemaine King, PSYD
• Cynthia Kingery, R.T.
• Kinship Development
• Gina Negri Klebanoff, LAC, DIPL OM
• Timothy Earl Korber, M.D.
• Christopher M Kovacs
• Gabor L Kovacs, M.D.
• Kaitlyn Kuo, PSYD

• Addiction (Substance Use Disorder) Counselor in Laguna Beach, CA
• Providers in Laguna Beach, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.