Provider Demographics
NPI:1558516799
Name:KIMBROUGH, TONIA (BSW)
Entity Type:Individual
Prefix:
First Name:TONIA
Middle Name:
Last Name:KIMBROUGH
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 W GRAND BLVD
Mailing Address - Street 2:STE 2000
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3096
Mailing Address - Country:US
Mailing Address - Phone:313-263-2408
Mailing Address - Fax:313-263-2409
Practice Address - Street 1:3011 W GRAND BLVD
Practice Address - Street 2:STE 2000
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3096
Practice Address - Country:US
Practice Address - Phone:313-263-2408
Practice Address - Fax:313-263-2409
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker