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General NPI Number Information
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NPI Number | 1548824378
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Entity Type | Individual
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Provider Name | KERTINA LYNESE KIMBROUGH LPC
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Gender | Female
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Dates
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Enumeration Date | 04/26/2019
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 5500 AUTO CLUB DR
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City | DEARBORN
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State | MI
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Zip | 48126-2779
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Country | US
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Telephone | 313-317-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 24 FRANK LLOYD WRIGHT DR # J2000
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City | ANN ARBOR
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State | MI
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Zip | 48105-9484
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Country | US
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Telephone | 734-747-6766
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401222259
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License Number State | MI
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