Provider Demographics
NPI:1689855942
Name:VICH, KIMBERLEE J (MA,LPCC)
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:J
Last Name:VICH
Suffix:
Gender:F
Credentials:MA,LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2363
Mailing Address - Country:US
Mailing Address - Phone:740-264-7751
Mailing Address - Fax:740-264-2422
Practice Address - Street 1:500 LURAY DR
Practice Address - Street 2:
Practice Address - City:WINTERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43953-3972
Practice Address - Country:US
Practice Address - Phone:740-264-1439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0500037101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMC24-01Medicaid
OHJE9149762Medicare PIN