Provider Demographics
NPI:1730671884
Name:WHITE, KIMBERLY
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:WHITE
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 1:217A MORAN AVE
Mailing Address - Street 2:
Mailing Address - City:MULLENS
Mailing Address - State:WV
Mailing Address - Zip Code:25882-1426
Mailing Address - Country:US
Mailing Address - Phone:304-294-4110
Mailing Address - Fax:304-294-4050
Practice Address - Street 1:217A MORAN AVE
Practice Address - Street 2:
Practice Address - City:MULLENS
Practice Address - State:WV
Practice Address - Zip Code:25882-1426
Practice Address - Country:US
Practice Address - Phone:304-294-4110
Practice Address - Fax:304-294-4050
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical