Provider Demographics
NPI:1508161092
Name:LEFF, KIM ADELIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:ADELIA
Last Name:LEFF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 ASPEN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-5501
Mailing Address - Country:US
Mailing Address - Phone:907-451-8208
Mailing Address - Fax:
Practice Address - Street 1:926 ASPEN ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-5501
Practice Address - Country:US
Practice Address - Phone:907-451-8208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK12961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical