Provider Demographics
NPI:1083800718
Name:CROW, KIMBERLY WALKER (MSW, MS, CMHP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:WALKER
Last Name:CROW
Suffix:
Gender:F
Credentials:MSW, MS, CMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5588 BERRY BROOK CIR
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-6321
Mailing Address - Country:US
Mailing Address - Phone:850-264-7123
Mailing Address - Fax:
Practice Address - Street 1:5588 BERRY BROOK CIR
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-6321
Practice Address - Country:US
Practice Address - Phone:850-264-7123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-17
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health