Provider Demographics
NPI:1497444962
Name:PICKERING, KIMBERLY (LSW, LCAC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:PICKERING
Suffix:
Gender:F
Credentials:LSW, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23105 DAISY HILL RD
Mailing Address - Street 2:
Mailing Address - City:BORDEN
Mailing Address - State:IN
Mailing Address - Zip Code:47106-9619
Mailing Address - Country:US
Mailing Address - Phone:812-896-3961
Mailing Address - Fax:
Practice Address - Street 1:618 E MARKET ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2914
Practice Address - Country:US
Practice Address - Phone:812-206-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33009763A104100000X
IN87001692A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker