Healthcare Provider Details

I. General information

NPI: 1538257407
Provider Name (Legal Business Name): KIMBERLEY L BALES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 CUMBERLAND RD
CEDAR BLUFF VA
24609
US

IV. Provider business mailing address

PO BOX 810
CEDAR BLUFF VA
24609
US

V. Phone/Fax

Practice location:
  • Phone: 276-964-6702
  • Fax: 276-964-5669
Mailing address:
  • Phone: 276-964-6702
  • Fax: 276-964-5669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904003559
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: