Provider Demographics
NPI:1265002976
Name:DUCHENE, KIMBERLY SUSAN (LLMSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SUSAN
Last Name:DUCHENE
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:SUSAN DUCHENE
Other - Last Name:NUNEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40539 FLAGSTAFF DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-3911
Mailing Address - Country:US
Mailing Address - Phone:248-295-1869
Mailing Address - Fax:
Practice Address - Street 1:11480 E 13 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2566
Practice Address - Country:US
Practice Address - Phone:586-216-9253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-26
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011100341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical