Provider Demographics
NPI:1508067869
Name:GAMBLE, KIFFANY SHANTREL
Entity Type:Individual
Prefix:MS
First Name:KIFFANY
Middle Name:SHANTREL
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 S. UNIVERSITY BLVD APT #348
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609
Mailing Address - Country:US
Mailing Address - Phone:251-533-3351
Mailing Address - Fax:
Practice Address - Street 1:3103 AIRPORT BLVD STE 410
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-3658
Practice Address - Country:US
Practice Address - Phone:251-470-2548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor