Provider Demographics
NPI:1659882264
Name:MARKHAM, KIMBERLY G (LISW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:G
Last Name:MARKHAM
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 N DETROIT ST STE 105
Mailing Address - Street 2:
Mailing Address - City:SUGARCREEK TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45385-2963
Mailing Address - Country:US
Mailing Address - Phone:937-610-4673
Mailing Address - Fax:937-736-2615
Practice Address - Street 1:36 N DETROIT ST STE 105
Practice Address - Street 2:
Practice Address - City:SUGARCREEK TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45385-2963
Practice Address - Country:US
Practice Address - Phone:937-610-4673
Practice Address - Fax:937-736-2615
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-23
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.17006621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical