Provider Demographics
NPI:1407830219
Name:FORD, KIMBERLY C (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:C
Last Name:FORD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 HANGING MOSS
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-3254
Mailing Address - Country:US
Mailing Address - Phone:210-566-0663
Mailing Address - Fax:
Practice Address - Street 1:VA
Practice Address - Street 2:7400 MERTON MINTER
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-617-5300
Practice Address - Fax:210-949-3326
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801079104104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker