Provider Demographics
NPI:1043931330
Name:KIMBER, ADAM GREGORY (LAC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:GREGORY
Last Name:KIMBER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6870 W 52ND AVE STE 214
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-3953
Mailing Address - Country:US
Mailing Address - Phone:303-898-9616
Mailing Address - Fax:
Practice Address - Street 1:6870 W 52ND AVE STE 214
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-3953
Practice Address - Country:US
Practice Address - Phone:303-898-9616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002014101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)