Healthcare Provider Details

I. General information

NPI: 1366807893
Provider Name (Legal Business Name): KIMBERLY DIANN MORALES MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2015
Last Update Date: 09/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 CRAMER CREEK CT
DUBLIN OH
43017-2586
US

IV. Provider business mailing address

2780 AIRPORT DR STE 100
COLUMBUS OH
43219-2289
US

V. Phone/Fax

Practice location:
  • Phone: 614-889-5722
  • Fax: 614-457-1040
Mailing address:
  • Phone: 614-859-1906
  • Fax: 614-645-5517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number51500514
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: