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General NPI Number Information
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NPI Number | 1710226352
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Entity Type | Organization
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Legal Business Name | LAURIE B. KIMMEL, LMSW, ACSW, PLLC
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Dates
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Enumeration Date | 02/01/2013
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Last Update Date | 02/01/2013
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Provider Practice Location Address
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Address Line | 5596 FOX HUNT LN
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-1639
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Country | US
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Telephone | 248-660-4637
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Fax | 636-582-5957
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Provider Business Mailing Address
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Address Line | 5596 FOX HUNT LN
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-1639
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Country | US
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Telephone | 248-660-4637
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Fax | 636-582-5957
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | LAURIE KIMMEL
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Credential | LMSW
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Telephone | 248-660-4637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6801057192
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License Number State | MI
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