Provider Demographics
NPI:1609215227
Name:ZIMMERMAN, KELLY RENEE (AADCP-IP)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:RENEE
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:AADCP-IP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 WAXWING CT
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-5379
Mailing Address - Country:US
Mailing Address - Phone:864-541-2755
Mailing Address - Fax:
Practice Address - Street 1:706 WAXWING CT
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-5379
Practice Address - Country:US
Practice Address - Phone:864-541-2755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical PractitionerGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)