1659796639 NPI number — MRS. KIMBERLY ERIN GROLL LCPC, CADC, CAMT

Table of content: MRS. KIMBERLY ERIN GROLL LCPC, CADC, CAMT (NPI 1659796639)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659796639 NPI number — MRS. KIMBERLY ERIN GROLL LCPC, CADC, CAMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GROLL
Provider First Name:
KIMBERLY
Provider Middle Name:
ERIN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCPC, CADC, CAMT
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:
1659796639
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
608 S. WASHINGTON STREET
Provider Second Line Business Mailing Address:
SUITE 207 ACHIEVING SOLUTIONS COUNSELING, INC.
Provider Business Mailing Address City Name:
NAPERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-632-4060
Provider Business Mailing Address Fax Number:
630-983-6474

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
608 S. WASHINGTON STREET
Provider Second Line Business Practice Location Address:
SUITE 207 ACHIEVING SOLUTIONS COUNSELING, INC.
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-632-4060
Provider Business Practice Location Address Fax Number:
630-983-6474
Provider Enumeration Date:
02/27/2014

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: 101Y00000X , with the licence number:  180008884 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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