Provider Demographics
NPI:1689831018
Name:KIMBROUGH, DEBRA
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:KIMBROUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 DELILAH RD STE 301
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5102
Mailing Address - Country:US
Mailing Address - Phone:609-272-8580
Mailing Address - Fax:609-645-7343
Practice Address - Street 1:13 N HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-3512
Practice Address - Country:US
Practice Address - Phone:609-272-8580
Practice Address - Fax:609-645-7343
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator