Provider Demographics
NPI:1417138801
Name:ALBERTS, KIM K (LCPC)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:K
Last Name:ALBERTS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:KIMBERLEY
Other - Middle Name:K
Other - Last Name:ALBERTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:300 N KENNEDY DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:BRADLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60915-1559
Mailing Address - Country:US
Mailing Address - Phone:815-929-0099
Mailing Address - Fax:815-929-1284
Practice Address - Street 1:300 N KENNEDY DR
Practice Address - Street 2:SUITE 8
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915-1559
Practice Address - Country:US
Practice Address - Phone:815-929-0099
Practice Address - Fax:815-929-1284
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004901101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)