Provider Demographics
NPI:1295193985
Name:TIMS, KIERRA (MA, LAC)
Entity Type:Individual
Prefix:
First Name:KIERRA
Middle Name:
Last Name:TIMS
Suffix:
Gender:F
Credentials:MA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 HALSTED ST
Mailing Address - Street 2:APT 401
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2665
Mailing Address - Country:US
Mailing Address - Phone:973-380-3798
Mailing Address - Fax:
Practice Address - Street 1:111 HALSTED ST
Practice Address - Street 2:APT 401
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2665
Practice Address - Country:US
Practice Address - Phone:973-380-3798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00296000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health