1528219748 NPI number — KIMBERLY WIMBERLY LCSW

Table of content: KIMBERLY WIMBERLY LCSW (NPI 1528219748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528219748 NPI number — KIMBERLY WIMBERLY LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WIMBERLY
Provider First Name:
KIMBERLY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528219748
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5750A SOUTHLAND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36693-3316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-662-7316
Provider Business Mailing Address Fax Number:
251-662-7297

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 BISHOP LN N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36608-5821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-450-2250
Provider Business Practice Location Address Fax Number:
251-342-2414
Provider Enumeration Date:
10/07/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  2079C , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)