Provider Demographics
NPI:1508224874
Name:SMITH, KIMBERLEY S (LCDC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:S
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 N LOOP 250 W
Mailing Address - Street 2:APT 1122
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-5227
Mailing Address - Country:US
Mailing Address - Phone:432-413-6228
Mailing Address - Fax:
Practice Address - Street 1:502 N CARVER ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-3634
Practice Address - Country:US
Practice Address - Phone:432-570-3390
Practice Address - Fax:432-570-3375
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11700101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)