Healthcare Provider Details

I. General information

NPI: 1982587341
Provider Name (Legal Business Name): KAHMIIL KOHRIE MIDDLETON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 RIVERSIDE DR APT C
SOUTH BEND IN
46616-1627
US

IV. Provider business mailing address

2400 CHERRY LAUREL LN
ALBANY GA
31705-4508
US

V. Phone/Fax

Practice location:
  • Phone: 574-383-8983
  • Fax:
Mailing address:
  • Phone: 574-383-8983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number99131736A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: