Provider Demographics
NPI:1588842199
Name:KIMBALL-KUBIAK, JULIE MARIE (MA)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:MARIE
Last Name:KIMBALL-KUBIAK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:MARIE
Other - Last Name:KIMBALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:34441 8 MILE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-4013
Mailing Address - Country:US
Mailing Address - Phone:248-345-2410
Mailing Address - Fax:
Practice Address - Street 1:34441 8 MILE RD STE 108
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-4013
Practice Address - Country:US
Practice Address - Phone:248-345-2410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802062699101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health