Healthcare Provider Details

I. General information

NPI: 1750795944
Provider Name (Legal Business Name): KIMBALL CLINICAL SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 W BEARSS AVE SUITE B
TAMPA FL
33613-1228
US

IV. Provider business mailing address

3323 W IVY ST
TAMPA FL
33607-1524
US

V. Phone/Fax

Practice location:
  • Phone: 888-899-7736
  • Fax:
Mailing address:
  • Phone: 813-766-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW10074
License Number StateFL

VIII. Authorized Official

Name: ALISON KIMBALL
Title or Position: OWNER
Credential: LCSW
Phone: 813-803-0879