Provider Demographics
NPI:1518295427
Name:JOHNSON, KIMBERLEY RENEE (MA, PC)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLEY
Middle Name:RENEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 SUMMIT RD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-2822
Mailing Address - Country:US
Mailing Address - Phone:513-948-0023
Mailing Address - Fax:513-948-0087
Practice Address - Street 1:1821 SUMMIT RD
Practice Address - Street 2:SUITE 216
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-2822
Practice Address - Country:US
Practice Address - Phone:513-948-0023
Practice Address - Fax:513-948-0087
Is Sole Proprietor?:No
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH05000271101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health