Provider Demographics
NPI:1669657300
Name:JAMES, KIM DEVONE (LPC,CADC, NCC)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:DEVONE
Last Name:JAMES
Suffix:
Gender:F
Credentials:LPC,CADC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2172 S EDGEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:OR
Mailing Address - Zip Code:97138-5128
Mailing Address - Country:US
Mailing Address - Phone:847-877-1867
Mailing Address - Fax:
Practice Address - Street 1:2172 S EDGEWOOD ST
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:OR
Practice Address - Zip Code:97138-5128
Practice Address - Country:US
Practice Address - Phone:847-877-1867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-006757101YP2500X
ORC4372101YM0800X
IL30612101YA0400X
OR16-R-58U101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)