Provider Demographics
NPI:1679742092
Name:FORD, KIMBERLY A (LPCC-S, LICDC-CS, MA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:FORD
Suffix:
Gender:F
Credentials:LPCC-S, LICDC-CS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30697 KING RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-9531
Mailing Address - Country:US
Mailing Address - Phone:330-853-6523
Mailing Address - Fax:330-453-6716
Practice Address - Street 1:320 MARKET ST FL 3
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2153
Practice Address - Country:US
Practice Address - Phone:740-314-5339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH070480101YA0400X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0210495Medicaid