Healthcare Provider Details

I. General information

NPI: 1295072320
Provider Name (Legal Business Name): CYNTHIA L KIMBALL, LMSW, ACSW, ACHP-SW, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 3 MILE RD NW SUITE 101
GRAND RAPIDS MI
49544-8209
US

IV. Provider business mailing address

640 3 MILE RD NW SUITE 101
GRAND RAPIDS MI
49544-8209
US

V. Phone/Fax

Practice location:
  • Phone: 616-785-8900
  • Fax: 616-785-8949
Mailing address:
  • Phone: 616-785-8900
  • Fax: 616-785-8949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. CYNTHIA LOUSIE KIMBALL
Title or Position: CLINICAL SOCIAL WORKER
Credential: LMSW, ACSW, ACHP-SW
Phone: 616-785-8900