Provider Demographics
NPI:1235603838
Name:LOCKHART, KIMBERLY R
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:LOCKHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7334 KNOLL CT
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-9689
Mailing Address - Country:US
Mailing Address - Phone:734-847-7600
Mailing Address - Fax:
Practice Address - Street 1:1701 W. SYLVANIA AVE.
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612
Practice Address - Country:US
Practice Address - Phone:216-208-0634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)