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General NPI Number Information
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NPI Number | 1861904088
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Entity Type | Individual
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Provider Name | CAROL KIMBROUGH MSW, LISW
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Gender | Female
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Dates
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Enumeration Date | 10/27/2017
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Last Update Date | 08/04/2022
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Provider Practice Location Address
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Address Line | 311 TRAILWOODS DR
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City | DAYTON
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State | OH
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Zip | 45415-2618
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Country | US
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Telephone | 937-572-3005
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 353
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City | ENGLEWOOD
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State | OH
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Zip | 45322-0353
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.2203628
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | S1440103
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License Number State | OH
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