Healthcare Provider Details

I. General information

NPI: 1154285021
Provider Name (Legal Business Name): MIKAYLA NOELLE KIMBALL CCMHC, NCC
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 ISLINGTON ST STE 2D
PORTSMOUTH NH
03801-4288
US

IV. Provider business mailing address

501 ISLINGTON ST STE 2D
PORTSMOUTH NH
03801-4288
US

V. Phone/Fax

Practice location:
  • Phone: 603-600-9125
  • Fax: 603-218-6749
Mailing address:
  • Phone: 603-600-9125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1028
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: