Provider Demographics
NPI:1306356761
Name:HEIL, KIMBERLY (LPC, AT-R)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:HEIL
Suffix:
Gender:F
Credentials:LPC, AT-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 BUNCE RD
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-3213
Mailing Address - Country:US
Mailing Address - Phone:860-212-0204
Mailing Address - Fax:
Practice Address - Street 1:35 COLD SPRING RD STE 122
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-3161
Practice Address - Country:US
Practice Address - Phone:860-212-2048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003204101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional