Provider Demographics
NPI:1508232539
Name:KIMBERLY YON-DAVIS, LCSW, PLLC
Entity Type:Organization
Organization Name:KIMBERLY YON-DAVIS, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:YON-DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:850-974-8045
Mailing Address - Street 1:1512 JOHN SIMS PKWY E # 353
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2143
Mailing Address - Country:US
Mailing Address - Phone:850-974-8045
Mailing Address - Fax:850-678-1720
Practice Address - Street 1:4393 COMMONS DR E STE 201
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-8482
Practice Address - Country:US
Practice Address - Phone:850-974-8045
Practice Address - Fax:850-678-1720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW117611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty