Provider Demographics
NPI:1023552841
Name:KIMBERLY M MCCREA
Entity Type:Organization
Organization Name:KIMBERLY M MCCREA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMSW
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCCCREA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:734-775-3451
Mailing Address - Street 1:47103 WATER'S EDGE LN #B217
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-3179
Mailing Address - Country:US
Mailing Address - Phone:734-775-3451
Mailing Address - Fax:
Practice Address - Street 1:2048 WASHTENAW ROAD UPPER LEVEL SOUTH SUITE
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1889
Practice Address - Country:US
Practice Address - Phone:734-775-3451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010585601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty